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post #41 of 63
I just wanted to say that I hadn't read the entire thread when I posted earlier... so when I was talking about anecdotes I was referring to the OP. I do think it is important to hear the first-hand accounts of losses, too. None of us is immune.
post #42 of 63
Quote:
Originally Posted by Bokonon View Post
Correlation does not equal causation.

High-risk births are more likely to be c-sections, therefore increased infant and maternal mortality would be expected.
Sure. But in the study they calculated (if I remember correctly) odds ratios, and eventually interpreted as risks. So it's not a (by common definition) situation where they are saying "there is a correlation between CS and death".

They are saying that, after holding all other things constant (depending on what they put in the model), the odds of dying were greater for women in the 'had a CS' group than for women in the 'didn't have a CS group'.

It's a logistic regression, which is used to predict the probability of something happening given certain 'risks'. So they aren't really saying that CS cause death, only that they increase the probability of death.

But I totally agree with the second part of your statement. And they do to, and tried to control for it (by assuming that they are studying the group 'women who had a CS but were not high risk').

Now whether or not they actually studied that group is the question. The point the homebirthdebate article made was that their assumption was faulty.
post #43 of 63
Quote:
Originally Posted by liz-hippymom View Post
" the OP has every reasonable reason to be scared when these things are happening around her. it is scary! and "trust birth" ? please! birth has been the leading killer of moms and babies since we walked upright.
I could see how someone could view the above statement as fear-mongering.
post #44 of 63
Quote:
Originally Posted by GuildJenn View Post
Just so you know that study was found to be really flawed: http://homebirthdebate.blogspot.com/...rmined-by.html
Jenn, you are one of my very favorite posters on MDC and I love what you write, but I have to point out that Dr. She Who Shall Not Be Named's website is not an acceptable or trustworthy source of information. She's overtly anti-homebirth in her agenda and I don't trust her analysis. That particular study may not have been good science, but I would need to see another analysis, other than one by Dr. You Know Who.
And as far as the other topic goes...I want MDC to be a welcoming place for all women who are willing to think intelligently about birth. That includes women who have lost a baby and no longer believe homebirth is their best option, as well as women who believe hospitals pose a danger to most laboring women, and other viewpoints in between. I reserve the right to respectfully express disagreement with any of those viewpoints.
The point is that we're having a thoughtful, largely evidence based discussion about birth, which is not something you can find on most web forums.
post #45 of 63
Quote:
Originally Posted by *MamaJen* View Post
Jenn, you are one of my very favorite posters on MDC and I love what you write, but I have to point out that Dr. She Who Shall Not Be Named's website is not an acceptable or trustworthy source of information. She's overtly anti-homebirth in her agenda and I don't trust her analysis. That particular study may not have been good science, but I would need to see another analysis, other than one by Dr. You Know Who.
Thanks for the compliment. It's definitely returned.

I don't know much about her but I did do a fast Google scholar run before posting that link and she is right - the data was very soft in spots, with very poor assumptions. If people are quoting the UNREVISED study then that needs to be corrected, IMO, and I thought that was a good summary of the flaws in the study.

Regardless, other studies in other countries still bring in the result that cesarian delivery does have more risks than vaginal which just makes sense if you think about it - surgery is a big deal no matter what kind of surgery it is for what reasons. It's just that the risk spread is not necessarily that wide apart. Let's look at the good data and studies - you don't have to find the one big discredited scary one to make your point.

Quote:
Originally Posted by *MamaJen* View Post
And as far as the other topic goes...I want MDC to be a welcoming place for all women who are willing to think intelligently about birth. That includes women who have lost a baby and no longer believe homebirth is their best option, as well as women who believe hospitals pose a danger to most laboring women, and other viewpoints in between. I reserve the right to respectfully express disagreement with any of those viewpoints.
The point is that we're having a thoughtful, largely evidence based discussion about birth, which is not something you can find on most web forums.
I think the evidence is often very cherry-picked on MDC (as it is pretty much everywhere) so I cringe a bit at the evidence-based phrase. I know I cherry-pick because I'm a lay person not investing weeks of research, or because someone has a really good summary. Hopefully if we all are willing to put a bit of time in the whole will be better than the sum of the parts.

I also think that stats are helpful but as someone who lived through losing my daughter (and watching her have seizures and be on morphine and poked and prodded during her short life), I also think that in our culture we gloss over what those stats really mean and these threads are an opportunity to stop doing that.

We just don't deal with death much or well - and death is not the only negative outcome in birth where brain damage is involved. We initially thought my daughter would live but be very, very handicapped (not able to swallow own saliva, hear, speak, or see).

These are rare outcomes, truly. But in absolute honesty in my case that was a fifteen minute difference. A c-section fifteen minutes earlier would have corrected the earlier mistake. And the on the other end, another five minutes and she probably would have been stillborn and we might not have asked as many questions although the outcome would have still be somewhat the same (although I do, weirdly, treasure those days.)

I have come to believe -- just as I believe in the cascade of interventions -- that one good way to look at risk is not just to look at the stats for each thing, but to consider how the pieces fit together too and what you can live with as failure points.

In order to do that you kind of have to understand how the pieces fit together, which is hard to do until you've been through it. That's why people's stories - biased and flawed as they are - are so important. They are more holistic in that way.

The downside is - normally, speaking for many women who experience perinatal loss - we just don't talk about it. The first response of many, many people -- and not just on the internet, trust me -- is to try to distance themselves from that experience and why it would never happen to them. I could tell you brutal stories.

When a woman reports a "good" birth here (even if there were, in fact, complications) it's "yay! for you!" - of course because we all revel in the joy of that child. And if that woman chooses that moment to share her personal truth in an advocacy way, it's acceptable.

But when it's a bad birth, suddenly the stats get trotted out and all kinds of accusations get levelled about fearmongering. IMO, it's not right. It's just not. If natural birth advocacy is about reality, then make room for that too. Everyone on this forum can understand that I personally will be insane about fetal monitoring and someone else will be biased about home birth - but our points of view, though from the minority (thank goodness) are just as valid as someone who had a really bad hospital experience. There is room for that.

The OP's question seemed very honest to me. Are there cases where in any birthing situation a different situation would result in a better outcome? Yes, totally.
post #46 of 63
Quote:
Originally Posted by Bokonon View Post
Correlation does not equal causation.

High-risk births are more likely to be c-sections, therefore increased infant and maternal mortality would be expected.
Exactly!
post #47 of 63
Quote:
Originally Posted by GuildJenn View Post
I think the evidence is often very cherry-picked on MDC (as it is pretty much everywhere) so I cringe a bit at the evidence-based phrase. I know I cherry-pick because I'm a lay person not investing weeks of research, or because someone has a really good summary. Hopefully if we all are willing to put a bit of time in the whole will be better than the sum of the parts.

I also think that stats are helpful but as someone who lived through losing my daughter (and watching her have seizures and be on morphine and poked and prodded during her short life), I also think that in our culture we gloss over what those stats really mean and these threads are an opportunity to stop doing that.

We just don't deal with death much or well - and death is not the only negative outcome in birth where brain damage is involved. We initially thought my daughter would live but be very, very handicapped (not able to swallow own saliva, hear, speak, or see).

These are rare outcomes, truly. But in absolute honesty in my case that was a fifteen minute difference. A c-section fifteen minutes earlier would have corrected the earlier mistake. And the on the other end, another five minutes and she probably would have been stillborn and we might not have asked as many questions although the outcome would have still be somewhat the same (although I do, weirdly, treasure those days.)

I have come to believe -- just as I believe in the cascade of interventions -- that one good way to look at risk is not just to look at the stats for each thing, but to consider how the pieces fit together too and what you can live with as failure points.

In order to do that you kind of have to understand how the pieces fit together, which is hard to do until you've been through it. That's why people's stories - biased and flawed as they are - are so important. They are more holistic in that way.

The downside is - normally, speaking for many women who experience perinatal loss - we just don't talk about it. The first response of many, many people -- and not just on the internet, trust me -- is to try to distance themselves from that experience and why it would never happen to them. I could tell you brutal stories.

When a woman reports a "good" birth here (even if there were, in fact, complications) it's "yay! for you!" - of course because we all revel in the joy of that child. And if that woman chooses that moment to share her personal truth in an advocacy way, it's acceptable.

But when it's a bad birth, suddenly the stats get trotted out and all kinds of accusations get levelled about fearmongering. IMO, it's not right. It's just not. If natural birth advocacy is about reality, then make room for that too. Everyone on this forum can understand that I personally will be insane about fetal monitoring and someone else will be biased about home birth - but our points of view, though from the minority (thank goodness) are just as valid as someone who had a really bad hospital experience. There is room for that.

The OP's question seemed very honest to me. Are there cases where in any birthing situation a different situation would result in a better outcome? Yes, totally.
Thank you for talking about something that is hard to talk about, and for sharing your experiences and insights with such clarity. I really appreciate what you bring to these forums.

I agree with everything you're saying about the uses & limits of statistical evidence, the importance of personal story telling in creating a holistic view of an insanely complicated process, and the difficulty of talking about death without "fearmongering."

One dynamic that I've noticed that seems as prevalent at MDC as elsewhere is a tendency to praise the method when something goes right, and to blame the woman when something goes wrong.

In other words, when there's a good outcome, we praise the worthiness of home birth/water birth/hypnobirth/Bradley method/UC/insert-your-preferred-method-here. When there's a bad outcome, there's a tendency to focus on the woman and how she was unprepared/uneducated/not trying hard enough/not "open" to the experience/not making the right choices/not advocating for herself/caving in to pain/you-name-it.

It's not so different than the medical model of focusing on heroic hospitals & OBs, sometimes to the point of ignoring the work of the laboring woman herself!

No matter where you're coming from, it can be hard to account for the random things that happen. Random good things happen & random difficult things happen. This doesn't sit well with our cultural obsession with control.

I think that this dynamic gets back to what the OP was asking about...our difficulty in knowing how to respond to things that are scary. Especially in a culture where the realities of death are as hidden and mysterious to most of us as the realities of birth.
post #48 of 63
Quote:
Originally Posted by UmmIlyas View Post
I could see how someone could view the above statement as fear-mongering.
well that someone might need to think twice and realize that my baby DID die because of birth, and could have been "saved by modern medicine" and without modern medicine- no thanks to my midwife- i did not die. 100 years ago? i would have been dead too. i have no fear mongering agenda, just the wish that no one else should have to go through what i went through for an "birth experience"
post #49 of 63
Quote:
Originally Posted by GuildJenn View Post
Also, no one was fear-mongering. Did you miss where this woman lost her baby? Of course that changes her perception. But her truth is important.
apparently not on MDC, although fear mongering about hospitals is widely practiced- mostly by people who have not lost anthing-

no big suprise here.if it weren't for the few understanding kind people on here, i would be gone in a heartbeat.
post #50 of 63
Liz, FTMP I agree with you. The point I was making was that a reasonable woman may choose a slightly increased risk of perinatal death to avoid a much higher increased risk of injury to herself and/or her baby. While obviously there is nothing worse than losing a baby, that risk (and the risk differential between home and hospital birth) is very small. A reasonable woman could choose to accept that slightly higher risk of perinatal death at home in exchange for lowering other, more common risks. Obviously anyone who has had a baby die at home would find it unacceptable, but I don't think that means we should make homebirth illegal. My point is that any woman choosing homebirth must be aware of exactly what she's choosing and be certain she wants to make those specific choices.

Also, I would say that the primary focus of modern obstetrics is on saving babies, not mothers. In fact, there is a very willing tradeoff wherein the threshold for substantially injuring the woman (c-section) is very low and modern obstetrics is also quite willing to risk the mother's life to save the baby. The ultimate unacceptable outcome is the preventable death of a baby. Therefore, heroic measures are employed, and a lot of technology, to try to always save every baby you possibly can. Even Dr. Amy has looked at this question and the diminishing return of doing more and more c-sections to save fewer and fewer (but still some) babies.

The philosophy is a bit different elsewhere - in other countries, such as Canada and the UK, there is a little less emphasis on always saving every possible baby. You can see this in the protocol for GBS+ mothers. In the US, the protocol is every woman who tests + gets prophylactic antibiotics, even though you're treating a tremendous number of women who ultimately won't need treatment and there are consequences to the treatment (though those consequences don't involve the death of an infant). In the UK, although a few more babies will die under this approach, they handle GBS+ mothers with expectant management and only administer antibiotics if the mother is symptomatic or has extended ROM or other additional risk factors. Under the UK approach, more babies die. Just a small number, but more babies die.

It isn't a cut and dry issue - the questions are complex. There are tradeoffs. There are risks and benefits. Reasonable people may differ. For the few who end up with the catastrophic, worst-case outcome, that is awful and no one wishes it on another person. Still, those few babies that didn't make it, or those few mothers who died on the table from the unnecessary c-section, shouldn't determine what care everyone else gets. It still has to be a balancing act, and a patient should still have the autonomy to choose and play an active role in her care and her baby's care.
post #51 of 63
Quote:
Originally Posted by CI Mama View Post
One dynamic that I've noticed that seems as prevalent at MDC as elsewhere is a tendency to praise the method when something goes right, and to blame the woman when something goes wrong.
I have seen this attitude far too often in the natural birth community. It is unhelpful and unacceptable.
post #52 of 63
Wow. A lot in this thread and a lot I could comment on, but I'm short on time.


Basically, OP:

Birth is not safe. Life is not safe. There are no guarantees and nothing you can do to prevent something truly unexpected from coming up.

However, the odds are far in your favor that your birth will go just fine. Most births go just fine. By far.

The important thing is that you trust the people taking care of you to do what is best for you and your baby, and you make choices that you know, in the extremely extremely small and rare chance that something bad happened, you could look back and say "I did everything I could with the information I had."
post #53 of 63
Thanks, Romana. That was a good post.
In some ways, for me I think the question in part is how much maternal morbidity is acceptable to reduce a small amount of infant mortality.
Would there be fewer numbers of infant mortality if every woman had a scheduled C-section at 38 weeks? Possibly. Would that lead to much higher maternal morbidity and likely maternal mortality? Definitely.
I do believe, based on studies that I have seen, that mortality rates are similar for home and hospital births, but homebirths have lower morbidity rates and much higher rates of maternal satisfaction. I do not believe that homebirthing is intrinsically and across the board more dangerous than hospital birth.
Also, some homebirth deaths are a result of malpractice, just like some hospital deaths. Liz, I don't know everything about your experience, but I know a little about it, and I know it sounds like better actions on the part of your midwife might have saved your baby. I guess some of that will be determined at the hearing. But the point is, the better trained and regulated midwives are, and the better the procedures are in case of transfer, the better the outcomes are overall.
post #54 of 63
I would just like to say that I am so sorry for any family that has lost a child. I am reading some unintentionally (I hope) cruel phrasing in some of these posts. I have lost children through miscarriage and helped several women who had stillbirths. After those experiences I am certainly aware of how words can make a mother's pain worse. Please remember that these "few more babies" have families that will be impacted for life. I realize no one is trying to be unkind but I think we can all make our points without sounding breezy about the loss of a child
post #55 of 63
Quote:
Originally Posted by liz-hippymom View Post
i have no fear mongering agenda
That is clear.
post #56 of 63
Quote:
Originally Posted by UmmIlyas View Post
That is clear.
are you being sarcastic?
post #57 of 63
Quote:
Originally Posted by liz-hippymom View Post
are you being sarcastic?
No. I'm not sarcastic. I am serious.
post #58 of 63
Quote:
Originally Posted by *MamaJen* View Post
Liz, I don't know everything about your experience, but I know a little about it, and I know it sounds like better actions on the part of your midwife might have saved your baby. I guess some of that will be determined at the hearing. But the point is, the better trained and regulated midwives are, and the better the procedures are in case of transfer, the better the outcomes are overall.
i agree 100% .but the OP was questioning the safety of homebirth. the US simply isn't there yet where i could say "yes it is just as safe". i know lots of people will pull up studies saying it is, but there are just as many saying it isnt.
and especially here in Austin where NO midwives (except the one practice in the hospital have OB backup. none. if my midwife had had OB backup, and therefor someone she had to check in with when things went bad, i would have been i the hospital almost from the begining of when she got there. but she did not. to homebirth here in austin (for sure) you must give up the safety net that is needed to keep babies from dying and being injured. there is a better way to do it. in other countries they do have better systems- but HERE? not right now. it is not as safe as it is touted to be on MDC. every midwife has a different experience level, and there is no way to know for sure what you are getting. stories like mine don't make the news. my midwife is still taking clients and i have heard from THREE interviewing mamas that she is not disclosing that she recently had a baby die, or that she is going in for a review that will probably cost her her license. so am i going to say something? yes! who else will?
post #59 of 63
I have never lost a full term baby. I have had 4 miscarriages. I do have close friends who have lost babies, at home and in hospital. In a few cases a different setting might have made a difference, in some it would have made none.

ALL of those women have been berated at some point for their choices - including one woman who was *planning* a homebirth (in the UK so under the normal NHS care everyone gets, but with the intention of calling the labour ward for a midwife to be sent out in labour, rather than going in to birth) whose baby was stillborn due to a cord accident which struck when she was 37+4 weeks pregnant. She was not in labour, she gave birth to him 4 days after he died, vaginally, in hospital following induction, there were two true knots in his cord, it seemed descent for engagement had pulled them tight. Still, people hinted that PLANNING a homebirth had caused this baby to die.

Likewise i know a woman whose baby died of cord prolapse in hospital after AROM (done by a midwife who missed the prolapse until it was too late, baby was delivered by csection, and never breathed, mama woke from the GA to be told her son hadn't made it) who has been told that she should have stayed home (she'd been in labour for days and they suggested the AROM as a way to help speed things up - the head was a little high, but he was her 3rd baby, it turned out at the section he'd had his elbow by his head and the cord had slipped through a gap between the arm and the head) and her baby would have lived.

The horrible fact is that some people will die. Some of those people will be tiny babies who never even got a chance at living. It's awful, it's probably one of the most unbearable facts of life there are. In specific cases, in retrospect, some deaths could have been prevented by a different setting, or a different care-giver, but sometimes nothing could have prevented them, and often there is no way of knowing ahead of time which setting or careprovider will be the "safest".

There is no silver bullet to protect ourselves from this. It's a risk we HAVE to take, no matter where we birth. For every woman the answer to the question "where is safest" is going to be different. I'm in the UK where homebirth is supported to an extent - midwives are all trained to the same standards and held to those standards, all the NHS midwives have automatic OB back-up at the hospitals they work for/at, and independent midwives can negotiate back-up with individual clients (i have an IM - i also booked with an NHS OB in case i needed one), and perhaps that DOES make homebirth safer here than it is in the US. On the other hand, some of the best midwives in the Western World live and work in the USA, and they would undoubtedly be a safe choice to birth with. There are certainly some midwives working in the UK who despite being well-qualified and monitored aren't a safe choice for homebirth. I was attended by one at my last birth, a midwife who was so lost without CFM and the ongoing access-to-VE's of an epidural'ed woman that she insisted i wasn't in labour until DD's head crowned. I was lucky, my birth was normal and she didn't intervene in any dangerous way. I have chosen a different care-model this time, in the HOPE that it will be safer for us, but i acknowledge that it is hope, and nothing more.

Scary birth stories exist because birth can be scary, terrifying, tragic. Just as joyful birth stories exist because birth can be peaceful, joyous, blissful. Both are incredibly important for women to tell and to hear, only if we hear both can we know the outer truth, and only by understanding that outer truth can we find our inner truths about how OUR births should be. The truth is not scaremongering, it is just the truth.
post #60 of 63
This was such a sad sad thread to read. ):

It makes me realize how much women go through, every day. We risk our whole selves when we choose to conceive and birth a child.
I wish we could be like other mammals and birth by ourselves, push the baby out in a minute flat, eat the placenta and be on our way. But unfortunately we have to walk upright and have big brains!

We all need to support each other. It makes me very sad to see how defensive and cruel pro-homebirth vs. pro-hospital birth mamas can be to each other. Each is probably coming from a unique experience that led her one way or the other.

Hugs to all the posters who have lost a child.
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