Homebirth Risks?

[magentamomma]

I am a dedicated homebirther. I have had all 4 children at home with the assistance of lay midwives, including a set of twins(first birth). I have always believed in the superior quality and safety, however I recently read an article that claimed that homebirth triples neonatal death. what i am wondering is if anyone knows who funded this research, and if anyone knows how they collected the data. I will always have my babies at home, butu I do not want to spout that homebirth is safer if it is not proven to be KWIM?

[mwherbs]

so what is the title of the article , who are the authors and where is it published as well as when was it published? I know that the Pang study in Washington state has some inflated numbers because they did not go by the midwifery info- they went with births that were not in the hospital -

[mwherbs]

oh yep I looked it is how someone is dividing up the Davis study- saying that 1.7 / 1000 for CPMs and that docs have a death rate of .63/1000- now the lowest stat I can find for my state in the 37-42 week range is 2.46/1000 at 39 weeks which is no where near what is being stated for medically attended term births.
I think that the biggest problem is that that the homebirths of multiples and babies with anomalies incompatable with life are all placed under the heading of low risk in the J&D paper which is not true and basically the term is not well defined but those births would be placed in the medical world as high risk- so it makes it hard to compare- especially since the medical folks have been deeming 1/3 of all birthing women as high risk enough to have a c-section - certainly we do not define things the same way.

[MsBlack]

The only articles I have seen that make such claims are written by people with a firm/fanatical opposition to homebirth. The really credible, objective studies done that compare hospital and homebirth in developed nations all show that neonatal death rates are the same. Both Canada and the Netherlands have recently published studies confirming this--and they are both nations where homebirth is fully supported within the health care system, where homebirth rates are fairly high.

[Kidzaplenty]

[AutumnAir]

Originally Posted by MsBlack

The only articles I have seen that make such claims are written by people with a firm/fanatical opposition to homebirth. The really credible, objective studies done that compare hospital and homebirth in developed nations all show that neonatal death rates are the same. Both Canada and the Netherlands have recently published studies confirming this--and they are both nations where homebirth is fully supported within the health care system, where homebirth rates are fairly high.

The only way they come up with numbers like this is to lump all out-of-hospital births into the same category, so putting precipitous births, births of teenagers who were trying to hide the pregnancy, births of homeless women, drug-addicts and all sorts of other births where the intent was not a 'planned homebirth'.

Any credible study will compare 'planned homebirths' with 'planned hospital' births and try to match the cohorts as well as possible for age, race, education and any other possible confounding factors.

All of the studies I have read have concluded that the risk of perinatal mortality is the same both in hospital and in a planned homebirth BUT the risk of injury to both mother and baby is higher in hospital. So, really homebirths are safer than hospital births if you want to get through the experience not just alive but in one piece too.

Check out the Research page on this website It is a UK site so not all the info is directly relevant to the US, but I think it's still very useful information to have.

[Tattooed Hand]

Originally Posted by MsBlack

The only articles I have seen that make such claims are written by people with a firm/fanatical opposition to homebirth. The really credible, objective studies done that compare hospital and homebirth in developed nations all show that neonatal death rates are the same. Both Canada and the Netherlands have recently published studies confirming this--and they are both nations where homebirth is fully supported within the health care system, where homebirth rates are fairly high.

I wonder if it makes a difference if homebirth is not supported within the heathcare system.

[MsBlack]

Well, the CPM2000 study, the Davis paper named earlier by mwherbs, is a homebirth study based in the US--where homebirth is not supported within the healthcare system.

[magentamomma]

http://www.sciencebasedmedicine.org/...homebirth.html

These are just 2 that i found

[magentamomma]

http://homebirthdebate.blogspot.com/...homebirth.html

[magentamomma]

Way bettter article
http://www.homebirth.net.au/2008/06/...cs-to-die.html

[MsBlack]

As for those 'negative links', all I can say is, Oh--HER. I thought, from your original post, that you must have stumbled into her bull hockey about hb.

She is well known for her completely NON objective stance, she fits into that category of 'fanatically against homebirth'. There is nothing she writes about homebirth that should be taken seriously, IMO--I mean, really. She is well-known for her untruthful, highly-distorted presentations of hb stats...I'm not sure what bee got into her bonnet over hb, but she is no one to take to heart. She does not want to be bothered by the facts--her mind is made up and she has made her life's purpose to try to destroy homebirth. Who can say why? But we all know the disturbed type that takes on an issue in an obsessive way, going to great lengths to try to 'prove a point' that may SEEM rational, but the whole thing is only an expression of deep personal distress, usually for reasons completely unrelated to the topic of their fanaticism.

If you look deeply into her blog (NOT that I recommend that by any means! It's a painful experience), it soon becomes obvious that there is no real logic in her rantings, that she is really truly not open to the truth, nor to any serious debate. Those who have challenged her are generally at first ripped-on, then banned from the supposed 'debate' (which is non existent--what she calls 'debate' is only a platform for her unshakeable position)--she simply will not tolerate anyone working to make her and her followers mindful of the truth.

And yes, there are numerous reasonable, fact-based studies and articles available concerning homebirth safety. I strongly suggest that you focus on those when you want to show someone the realities--and don't share HER stuff at all. It is not credible in the least. I don't even mind sharing info about the potential 'downside' of homebirth--I think ppl should be well aware of all risks and benefits in any important choice in life! But *that* junk is so NOT reality-based that it really doesn't fit as useful info for anyone.

[nashvillemidwife]

The thing to remember is that any one study is going to have its limitations. The question is, how do the results of that one report compare with all the others? Does it duplicate the same findings as a wealth of other studies done? If not, why are these findings out in left field compared to the others? Here is a mostly comprehensive summary of the research, good and bad (there have been two more studies published showing safe outcomes since this page was last updated): www.nashvillemidwife.com/safety.html

[S.Elise]

Originally Posted by Tattooed Hand

I wonder if it makes a difference if homebirth is not supported within the heathcare system.

I hear this point, but you need to remember that due to our non-evidenced-based, profit-driven practices in hospital births, hospital birth here is way more dangerous as compared to hospital birth in the UK or Netherlands, where there is at least an attempt at putting women's welfare first.

So while I'm sure that HB is made more dangerous here by the fact transfers are problematic due to lack of support at the hospital, ALL birth is more dangerous here than in Europe., so I bet it cancels out.

[MsBlack]

good point, stella rose! excellent point in fact

[Turquesa]

Originally Posted by MsBlack

Both Canada and the Netherlands have recently published studies confirming this--and they are both nations where homebirth is fully supported within the health care system, where homebirth rates are fairly high.

I'm a huge home birth advocate, here. But to be fair, couldn't somebody counter that they have different (i.e. "better" or more rigorous) training standards for the MWs in Canada and the Netherlands?

I've heard this through the rumor mill, but nobody has given me any specifics as to how MW training differs in those countries. Any idea?

[lovebug]

[BirthSense]

Improperly applied statistics

Sounds like the Pang study. I was living in Washington state and working as a midwife when this study was done. They included ALL out of hospital births, planned or not, in their numbers. This included fetal demises/miscarriages after 20 weeks. Obviously, this greatly increased the "neonatal death rate", even though a 21-week demise is not exactly the same as a full term infant who dies during a planned home birth.

Had they used the numbers for planned homebirths attended by a birth professional, the statistics would have shown what other studies have indicated: no statistically significant difference in neonatal mortality, with fewer complications of labor & birth.

[Eresh]

I may catch some flack for this but I do think there are some situations where a mom or baby might die at a homebirth where they might have been saved at a hospital. The flip side of that is the hospital culture of obstretrics interferes so greatly with physiological birth processes, the moms and babies die there that would not have died if they had just stayed home. Both groups of people are a very, very small percentage of moms/babies. For example, amniotic fluid embolism, which occurs in something like 1 in 60,000 births happens pretty much exclusively in hospitals so far as I can tell and kills almost all women to which it happens.

To me the greater concern is that much larger percentage of women that go to the hospital hoping for an uneventful, natural birth and, after getting railroaded by the hospital obstetrics culture, is left recovering from major surgery and wondering what happened. The studies PPs have cited show that mortality is about the same between planned homebirths and hospital births among women with low risk pregnancies, however morbidity is much higher in the hospital. In my mind, how my children enter the world is very important -- not only for them but for our family as a whole. Nurturing a newborn is hard enough without mom also suffering physical and emotional wounds.

[mwherbs]

the gals in part of Canada atleast started as CPMs but because they can also care for their moms in hospital the segment of training as far as management in hospital needed to be added that includes rxing meds - so no more rigorous - basically an added setting and fuller scope of practice --- but that change is fairly recent.