Studies/ evidence regarding homebirth safety?

[mamatoElias]

Does anyone have some information they can share with me regarding the safety of birthing at home? I am very much wanting a homebirth with this baby, but my husband is terrified of the idea. I won't homebirth if he feels like it is putting our baby at risk, but would really like to provide him with some legitimate data. I'm hoping he will reconsider. He is quite academic so I am looking mainly for peer reviewed research or journal articles.

His main concern is that we live 20 minutes from the nearest hospital (and 30 minutes from a hospital with a NICU). He finds this to be an unacceptable risk. There is a birth center 5 minutes from a different hospital. Our current plan is to birth there, but I'm not as comfortable with the midwives there. I found a homebirth midwife I love. She is very experienced and it just feels right. She has a wonderful back-up MD who I can meet with during my pregnancy. This will be my third baby. My first two births were relatively easy and uncomplicated. I feel safest at home. I felt violated and somewhat traumatized by my last birth experience. Also, my last birth was very quick and I am afraid this one may be too. I don't want to give birth in the car on the way to the birth center.

Sorry for rambling, but any data anyone can share is much appreciated! Thanks.

[MsBlack]

I don't have the links handy--but I'm guessing someone does--there are 2 very current and large studies out there at the moment, comparing planned, attended homebirth to hospital birth. One is from Canada, and one from the Netherlands--2 nations that have quite a bit of homebirth. There may also be something from the UK, can't remember any studies but as I understand it the Nat'l Health Svc there is favoring more women have homebirth because it's cheaper and just as safe for low risk women.

Anyway, the studies out of the Netherlands and Canada are quite good. I'm sure someone will post the links--or a link to discussion here that has those links in it. You could try googling them, too...

and good luck in helping your dh see the light! Birth is too important an event in our lives, not to go for what we most want

[mamatoElias]

Thankyou! I'll see if I can find those studies on the internet.

[nashvillemidwife]

www.nashvillemidwife.com/safety.html

[Earthy Mama]

I don't have any studies handy, either, but my dp was very concerned about the safety factor. We are 30 weeks and just decided to switch to a HB since our CNM left the hospital.
What helped him tremendously was talking with the midwife that we are hiring-she eased his mind about everything. Good luck!

[smeep]

You say you live 20 minutes from the nearest hospital? Well, to my knowledge, the OR prep time for a cesarean is around 17 minutes (someone correct me if the time is wrong?)...your midwife could call them and have them prep the OR while you're on your way. Not to mention you add in the fact that, most likely, your midwife would detect an issue before the average OB or RN would (I say this simply because she knows YOU and she's around the whole time - no waiting for an RN to finally check on you and then think something might be wrong and then page the OB and then OB gets there and then OB does his own thinking and THEN they tell the OR to prep a room).

You may also want to look up their cesarean rate and compare it with your midwife's. I can almost guarantee they have a much higher section rate for low-risk women (hospitals with equal rates are almost non-existant). Not to mention all their other intervention rates (ask about pitocin use both for induction and augmentation, EFM which has been known to cause more harm than good in most low-risk cases, etc.)...when you add all the numbers up it should be pretty obvious that, unless interventions truly become necessary, it's not worth their added risk!

ETA: I am a prime example of what could have been a risky, harmful birth if I had had prenatal care and birthed in a traditional hospital. My midwife referred me out for an ultrasound at 41w3d just to make sure everything looked good. During the ultrasound DS was not moving around a whole lot and they FREAKED. As in, "Don't even go home, go straight to the birth center and have you induce IMMEDIATELY!" (Umm, hello? Freestanding birth centers CAN'T do inductions that are that immediate because they don't have pitocin!) My mother was with me and when we walked out she told me that she thought I was in early labour and that's why he was slowing down because all her babies slowed down during early labour. We went home and called my midwife who agreed. Sure enough, he was born 14 hours later with only 5 1/2 hours of active labour. Can you imagine just how differently it would have turned out if I had been having traditional care? I probably wouldn't have even had the chance to go in for that ultrasound at 41w3d because they wouldn't have "let" me go past 41w!

[Partaria]

First of all, congrats on the impending arrival of your little one, mama!

I'm in a similar boat with some family members right now (though not DH) so I can partly sympathize.

One thing you might try is sitting down with DH to watch the truly excellent documentary The Business of Being Born. My husband saw that film even before I did, and when I told him I was pregnant, he was initially more open to HB than I was!

It's available on Netflix and Netflix watch instantly, or you can rent it online at the film's website.

In the film, several experts and OBs go over the pros of HB and the evidence for its safety. You'll also get a good explanation about how unneeded hospital interventions lead to more cesareans, and how in many cases HBs are actually safer.

Like the film says, many people think women can't birth their babies at home because we don't see that anymore. It isn't done, so we don't believe it CAN be done, if that makes sense. DH will also have the chance to see several women birth babies at home in this film, and the joy and love is palpable even though the medium of film.

There is even one birth in the film in which a woman who planned an HB must transfer to a hospital. The midwife has no reservations making that call correctly and in a totally timely manner. Baby and mama were totally fine.

Much luck and love to you, mama. Let us know how it goes.

[mamatoElias]

Originally Posted by nashvillemidwife

www.nashvillemidwife.com/safety.html

Exactly what I was looking for. Thankyou!

I will also ask him watch the Business of Being Born. I wouldn't mind watching it again myself, so we'll have to have a movie night.

I am aware that an OR takes 20-30ish minutes to get ready, so it could ideally be set when we arrived. I've already discussed that with my husband. He still feels 20 minutes is too far from the hospital. The c-section rate at the hospital nearest to the birth center we are currently planning to birth at is around 33%, but to be honest, my husband won't be swayed by a comparison of intervention rates. As long as the baby is fine, he would be perfectly fine with a very medically managed birth. I would not be. He thinks I am being selfish. I hate that this is causing tension between us. I'm hoping if I can get him to actually do some research he will reconsider his position. Or maybe I just need to reconsider mine. I won't plan a hospital birth, but maybe the center 5 min from the hospital is the best compromise.

Thanks again for your input and the info!

[smeep]

The problem is that those babies with all those interventions are NOT "just fine." Higher rates of breathing difficulties, prematurity, NICU stays, physical injury, etc. And all sorts of higher rates of complications for mum as well. I'm sure someone can direct you to a list. And birth injuries for mum can lead to serious risks for subsequent pregnancies both for mum and baby. Even a "successful" cesarean with no short-term complications still significantly increases various risks for subsequent pregnancies, regardless of how they end (VBAC or RCS).

[IdentityCrisisMama]

One of the most compelling stats to me is the list of US infant and maternal mortality compared to other nations in the world. Have you seen that? An article like this may at least open him up to the idea that our medical care for babies and mom isn't all that great:

"U.S. has second worst newborn death rate in modern world, report says"

http://articles.cnn.com/2006-05-08/h...s?_s=PM:HEALTH

[mamatoElias]

Originally Posted by smeep

The problem is that those babies with all those interventions are NOT "just fine." Higher rates of breathing difficulties, prematurity, NICU stays, physical injury, etc. And all sorts of higher rates of complications for mum as well. I'm sure someone can direct you to a list. And birth injuries for mum can lead to serious risks for subsequent pregnancies both for mum and baby. Even a "successful" cesarean with no short-term complications still significantly increases various risks for subsequent pregnancies, regardless of how they end (VBAC or RCS).

I am too well aware of the complications that unnecessary interventions can cause. And my husband has heard it all before as this is our 3rd pregnancy. Unfortunately, he feels the hospital is able to deal with these complications effectively. A NICU stay wouldn't bother him much as long as baby made a full recovery. But there would be no one there to deal with an emergent, unexpected complication at home. I don't know how to argue with the fact that, on rare occasion, there will be a baby who immediately needs the help only a NICU can offer. My husband feels like he couldn't handle it if our baby was one of the few who needs that help even if homebirth is safe "statistically" speaking. FTR, I'm not wanting to make my husband sound awful. He's a great guy who just really wants for both me and our daughter to be safe. We see things a little differently and have different ideas of where the safest place is.

[mamatoElias]

Originally Posted by IdentityCrisisMama

One of the most compelling stats to me is the list of US infant and maternal mortality compared to other nations in the world. Have you seen that? An article like this may at least open him up to the idea that our medical care for babies and mom isn't all that great:

"U.S. has second worst newborn death rate in modern world, report says"

http://articles.cnn.com/2006-05-08/h...s?_s=PM:HEALTH

Thanks! I'll pass this one on to dh.

[IdentityCrisisMama]

There is probably a better article than that one, which dealt mostly with issues of poverty and poor prenatal care. The simple graph showing where the US is is great as would be a comparison of, say, Dutch birth safety to US.

[IdentityCrisisMama]

This one is good!

http://www.midwiferytoday.com/articl...ogyinbirth.asp

[Partaria]

Just chippin' in my two cents here. Another good way to round up evidence, as others have mentioned, is to go straight to your local hospitals.

I asked ours what their c-section rate is, but I also asked the following:

1. How often to you perform episiotomies?
2. How long would a woman labor before you would recommend pitocin?
3. If a labor is not progressing, what measures you you recommend other than administering pitocin?
4. Do you have waterbirth facilities?

Some of these questions can reveal to homebirth hold-outs that the hospital is a more rigid environment with greater rates of interventions that aren't needed. One of my local hospitals told me a women might labor for 3 hours before getting pitocin. Only three hours?! Geez, give a lady a chance!