Dear Colleagues
Please see an Editorial, letters and and authors response to the above paper.
Regards
Jane Sandall
http://www.ajog.org/article/S0002-9378%2811%2900080-9/fulltext
Editorial
American Journal of Obstetrics & Gynecology
Volume 204, Issue 4<http://www.ajog.org/issues?issue_key=S0002-9378(11)X0003-0> , Page e20, April 2011
We have received numerous letters to the editors regarding the article by Wax et al: Maternal and newborn outcomes in planned home birth vs hospital births: a metaanalysis, published in the September, 2010 edition of the Journal. Five of these letters are selected to be published here with the reply from the authors. In response to the concerns that were expressed in the letters, the American Journal of Obstetrics and Gynecology convened an independent review panel to (1) review the article that was published and these letters to the editors and (2) make recommendations to the Journal. The review panel consisted of 3 panelists who are all specialists in maternal fetal medicine, with expertise in metaanalysis and clinical research. The panel was provided a copy of the manuscript that had been submitted (Wax et al1<http://www.ajog.org/article/S0002-9378%2811%2900080-9/fulltext#bib1>) and all of the letters to the editors. In addition, after its initial review, the panel requested additional information from Dr Wax, the corresponding author of the article, that would include the individual summary graphs for each outcome that was presented in the manuscript. Each member of the panel reviewed the information independently, and consensus was reached in a conference call.
There were a number of issues raised in the letters, many of which the panel believed were subjective and should be debated openly. The issue that the panel focused on was the "numbers" that were included for each outcome in the metaanalysis. The panel reviewed several outcomes and attempted to reconstruct the results of the metaanalysis. In all 3 cases, 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.
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.
______________________________________________________________________________
Jane Sandall
Professor of Social Science and Women's Health & Programme Director (Innovations) NIHR King's Patient Safety and Service Quality Research Centre
Division of Women's Health, School of Medicine, King's College London 10th Floor, North Wing, St. Thomas' Hospital, Westminster Bridge Road LONDON SE1 7EH
Tel: 020 7188 8149
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