Homebirth Studies in the Medical Community

[gretae]

Strong advocate for homebirth and have had all my babies at home and just want people to be aware of the studies the medical community have been doing.

Maternal and Newborn Outcomes in Planned Home Birth vs Planned Hospital Births: A Meta-analysis
Wax JR, Lucas FL, Lamont M, Pinette MG, Cartin A, Blackstone J
Am J Obstet Gynecol. 2010;203:243.e1-243.e8

Planned home births involved fewer interventions; they involved less epidural use, lower rates of electronic fetal heart rate monitoring, and lower rates of cesarean delivery. In general, rates of maternal complications were also lower with planned home deliveries. Neonatal outcomes were not favorable with planned home delivery, however. Although birth of a premature infant (0.8% vs 4.7%) and birth of a low-birthweight infant (1.3% vs 2.2%) were less common among planned home deliveries than planned hospital deliveries and perinatal death rates were the same in both groups (0.07% vs 0.08%), neonatal death rates were higher among planned home deliveries (0.20% vs 0.09%), corresponding to an odds ratio of 1.98 (95% CI, 1.19-3.28).

additional text removed due to copyright... please see original study (via medline) for details.

[turnquia]

I personally would love to hear if of the planned homebirths that transfered how many had OB back up care, were in an area where homebirth with midwives was legal, and if the homebirths were planned with midwives or planned UC homebirths.

Having a good transfer system in place without the fear of legal ramifications and poor treatment most certainly affect when mother/midwife etc feel comfortable to do an actual transfer. As well as whether the homebirths were planned with midwives or not.

The countries with good homebirth rates have clear set guidelines for transfer for midwives as well as homebirth being supported so transfers go smoothly without the fear of being prosecuted or recieving poor treatment.

I'd be willing to bet that this plays a large effect on those numbers....

[NewSolarMomma]

The thing about other countries like Canada and Netherlands is that they are MUCH more regulated. The MWs have very extensive training, and there are many guidelines as to which women are even allowed to attempt a HB. HB and midwives are part of the healthcare system, so things like testing and transfers are standardized.

In the US there are two kinds of MWs: the CNMs, who don't typically do HBs but have a Masters in Nursing, and DEM/CPMs, who can be required to have as little as one year of training and experience at 20 births (I think 10 attended, 10 deliveries, but I could be wrong). This allows them to be licensed (MANA) in states where they are allowed to practice. The US CPMs would NEVER be allowed in CanadaNetherlands/England.

Keep in mind that IF the USA had a system like Canada/Netherlands/England there would also be NO HBACs, NO Breech HB, NO multiple HB, etc, like you have in the USA. HB would be safer, but would be MUCH more limited!

I say be careful what you wish for, you just might get it!

[Defenestrator]

Originally Posted by NewSolarMomma

In the US there are two kinds of MWs: the CNMs, who don't typically do HBs but have a Masters in Nursing, and DEM/CPMs, who can be required to have as little as one year of training and experience at 20 births (I think 10 attended, 10 deliveries, but I could be wrong). This allows them to be licensed (MANA) in states where they are allowed to practice. The US CPMs would NEVER be allowed in CanadaNetherlands/England.

It's true that there are direct entry midwives who are practicing who have had very minimal training, but the CPM and CNM minimum clinical hours are about the same. Most CPMs will put in more clinical hours than CNMs in their training. The bare requirement is 40 births, not 20. CNMs are required in many programs to also only deliver 20 babies before graduation and those 20 babies might mostly be delivered within one 6 week period at the end of their training. Both CNMs and CPMs typically attend a lot more births than that before their training is finished. I attended about 100 births before I got my CPM. I think that's typical. I also trained for nearly 5 years. I think that 3-4 years is typical. The 1 year minimum requirement is there so that women don't do all of their training in a short period of time at high-volume birth centers. The CPM I know who did the shortest training trained in Amish country for 18 months and attended 120 births during that time. She saw multiple breeches, twins, preemies, and other complicated births, way more than most midwives would during that time.

It is true that England and the Netherlands have very specific requirements for midwives' education, but Canada has been more flexible. Most of the midwives who licensed in the '90s when Ontario and BC got licensing were apprentice-trained. I have looked into immigrating to Canada and several provinces would recognize my CPM training and just put me into catch-up classes and short-term clinical placements to teach me how to do hospital births, pitocin, epidurals, prescribe drugs, etc. This training could be as short as 12 weeks.

I don't want to start a big debate about CNM vs. CPM training. I think there is value in both. I just hired a CNM to work in my homebirth practice and though she's still working on learning homebirth skills, there are things she knows that I don't know and I value her knowledge. When she is totally trained, she's going to be awesome and in many ways she's already awesome.

[jgale]

The Wax study was a meta-analysis which included some very poor studies--including a big one from Washington State where they didn't distinguish between planned and unplanned homebirths (ie. someone delivers their baby in the car on the way to the hospital, etc).

It has been widely criticized in the medical community...

[*MamaJen*]

Yeah, the Wax meta-analysis is best characterized by the phrase, "garbage in, garbage out."