Statistics

[mamahen2coop]

Does anyone have any statistics on outcomes of UC vs HB?

[xelakann]

I could be wrong here, but I am not sure a scientific study has been conducted. There are still very few studies comparing home births and hospital births.

[mamahen2coop]

thanks.  I figured that's why I was having a hard time finding anything.  I figured if someone had found something it'd be you all.  :)

[ElizabethE]

This would largely have to do with UCs being intimate and non-studied events, by their very definition. You wouldn't really be having a UC if you had people in lab coats taking notes and measurements, or recording stats, would you?  :) This makes it a little trickier to track with exact numbers.

That said, most statistics we get these days seem to come from reports of people who've had experiences. That's kind of all we have since UC is a private event. We have merely to listen to the stories of others. Maybe someone could go around and take a census tally or something to rate satisfaction and healthy outcome and whatnot. :)

While not as official sounding, I would like to say that on the accounts I have heard and the accounts I have read, there are far more incidents of "complication" with home births than with UC. I personally sum this up with anything that de-normalizes birth, including perceived or real medical interference, disrupts the body's normal birthing process and creates this self-fulfilling prophecy of the need for intervention or medicalized care. The laboring woman left alone to trust her body and her instincts, subjected to less prodding and testing and interruption, will typically have an easier labor without any complication. Most attended home births I hear about-- even the good ones-- have even a little bit of an "uh oh!" factor to them. The reason for this is extremely primal and physiological. We don't spend enough time trying to understand the science/biology of how we birth-- we're too focused on what to do WHEN a disaster happens, or how to treat something IN CASE of an emergency. With this focus on the effect but not the cause, it's no wonder we are fixated as a society on having attendants near. Personally, I think the best kind of care is always preventative. :)

I did, however, find one site that was attempting to gather some statistics on the subject. It's not as vast as numerous scientific and medical studies we are more used to, but it gives us a rough idea. It's a good jumping off point to something that is hard to assign numbers to in the first place, that's for sure:

http://www.unhinderedliving.com/stats.html

[rainbow_mandala]

Originally Posted by ElizabethE 

We don't spend enough time trying to understand the science/biology of how we birth-- we're too focused on what to do WHEN a disaster happens, or how to treat something IN CASE of an emergency. With this focus on the effect but not the cause, it's no wonder we are fixated as a society on having attendants near. Personally, I think the best kind of care is always preventative. :)

I feel this gets to the root of the matter of why UC is the conscious choice for many of us who take this path.  Instead of preparing for all the "what ifs", we understand as best we can our own bodies, its signals, the nature of birth (not just physically but emotionally, spiritually, mentally), how to embrace the experience rather than simply manage it, learning how to listen and trust our intuition, and doing what we feel is necessary to prevent any difficulties from arising (often through nutrition, exercise, good sleep, relaxation, self-reflection, etc.).  It's simply a different approach, often times.  Thus, gathering statistics isn't as purposeful since, number one, we're not trying to manage things, and, number two, birth is personal, not only for the woman but for each time she gives birth.  Being as present as possible is really the only "solution"

[mamahen2coop]

Thanks.  I'm having some serious internal debates over delivering in the hospital vs midwife and am having a hard time finding a midwife period.  So now I'm going to research UC more and see if it's something I think I could do.  :)  

[MeepyCat]

Originally Posted by ElizabethE 

I did, however, find one site that was attempting to gather some statistics on the subject. It's not as vast as numerous scientific and medical studies we are more used to, but it gives us a rough idea. It's a good jumping off point to something that is hard to assign numbers to in the first place, that's for sure:

http://www.unhinderedliving.com/stats.html

I can't speak to the accuracy or value of statistics from this site (although I note that the sample size is quite small).  However, I want to advise extreme caution with the advice from this site.  On several topics, the writer is factually incorrect, and in at least one case, I would expect following her advice to lead to maternal and infant death, and a homicide investigation.  I would classify the online childbirth class material as dangerous, and I wouldn't believe ANYTHING from that material unless I could confirm it from a reputable source.

[ElizabethE]

Mama Hen-- you go, girl. Please let us to continue to inform, empower, and encourage you on your path. We will be very open and honest and as candid as we can be, those of us who are into UCing.

Meepy-- your input is very much appreciated. Caution is definitely something we must keep in the front of our minds. If you have any specifics as to the dangerous info from that site, I'm sure it would be extremely helpful and informative to those of us here who are yet unaware of such facts. Thanks! :)

[mamahen2coop]

Elizabeth E- Thanks for the encouragement!  Im still really conflicted about the whole thing.  But between watching Orgasmic Birth and The Business of being Born and reading Birthing from Within, and I"m reading Ina Mays Guide to Childbirth right now, it just really makes me feel that I am totally capable of doing this on my own with no one's interference.  I'm totally low risk, had a quick and easy labor with my first, and have no reason to expect anything different with this one. 

Off topic, but do doulas attend UC's?  I, myself, know NRP and would be able to do resuscitation, and have equipment minus 100% O2, on hand.  But, could I count on myself to do CPR on babe if it came about? 

[ElizabethE]

Jenica, that's perfectly normal and understandable. :) If it's right for you, you'll know with more certainty at some point. You definitely need to take your time and make sure you are feeling it in every way. For some of us, we explore it and it just eventually HITS.

As a rule, I don't think doulas attend UCs. I think even though they are not considered medical, having them there in a capacity which is still sort of a birth attendant counts as attending or assisting and then negates the term "unassisted" in UC. I feel that you could probably do infant CPR if you had to, but you really need to find the confidence in your education on that topic. You need to really believe in yourself that you could do whatever it takes, just as well as or even better than a professional with the same training. Aside from CPR, there are other natural and instinctive ways mothers will use (without even realizing it) to try to get their babies to respond. Of course, most babies will never need this.

A doula may potentially hinder the birth process by being there, so it's just something to think about more as you explore this for yourself. :)

[major_mama11]

A basic NRP overview if anyone is interested, if anyone is on the lookout for an alternative source of info during your preparations. The first 4 pages or so are pretty helpful in any birthing environment I think. 

http://www.lifesavered.com/NRPGuide.pdf

Happy and healthy births to all!

[mamahen2coop]

Originally Posted by ElizabethE 

Jenica, that's perfectly normal and understandable. :) If it's right for you, you'll know with more certainty at some point. You definitely need to take your time and make sure you are feeling it in every way. For some of us, we explore it and it just eventually HITS.

As a rule, I don't think doulas attend UCs. I think even though they are not considered medical, having them there in a capacity which is still sort of a birth attendant counts as attending or assisting and then negates the term "unassisted" in UC. I feel that you could probably do infant CPR if you had to, but you really need to find the confidence in your education on that topic. You need to really believe in yourself that you could do whatever it takes, just as well as or even better than a professional with the same training. Aside from CPR, there are other natural and instinctive ways mothers will use (without even realizing it) to try to get their babies to respond. Of course, most babies will never need this.

A doula may potentially hinder the birth process by being there, so it's just something to think about more as you explore this for yourself. :)

I've been certified in it for the past 6 years and have actually had to do it a couple times so i could do it technically, but Im wondering would I physically be able to do it.  I'm imagining I'd have to clamp and cut the cord to give myself enough room to do it right? 
 

[MeepyCat]

ElizabethE, there are two areas where Unhindered LIving has caught my attention, because they're conditions I've dealt with personally:  Rh incompatibilities, and placenta previa.

When I read the material over there on Rh factors, I thought the writer was silly - foolish and incorrect - but I considered her mostly harmless.  The writer (Judie Snelson?  That's who's named in the copyright), claims that:  "For thousands of years, mothers have given birth unassisted by medical technology.  There was never a problem with blood incompatability."  This is hugely, massively, horrifically false.  Hemolytic disease of the newborn was well described in medical literature centuries before we had any idea of the cause.  The first description we have of the disease comes from the memoirs of a French midwife in 1609.  For centuries, this disease was tragic and inexplicable.  You didn't hear about blood factor incompatibilities because we lacked the technology to discern that there were such things as blood factors.  Snelson claims to know of two women who changed over from Rh- to Rh+ (according to lab tests run by doctors), and suggests that "blood cleansing" diets might help change maternal blood from Rh- to Rh+.  I don't see how cleansing blood could introduce an immune factor that wasn't previously there.  By contrast, I find it quite easy to see how laboratory errors could lead to conflicting test results.

I'm putting the placenta previa stuff behind a spoiler tag.  When placenta previa doesn't resolve prior to delivery and assistance is not available, the condition kills healthy women and healthy babies.  Details on Snelson's advice are behind the tag.  The material may be triggering for maternal death, and infant loss, and there is a graphic description of a primitive obstetrical procedure and its consequences.

Warning: Spoiler! (Click to show)

From Unhindered Living:

Most people believe that a diagnosis of placenta previa means an automatic c-section.   Placenta previa involves partial or complete coverage of the cervix by at least a portion of the placenta.  The danger of placenta previa lies mostly in the possibility of hemorrhage.  It is believed by most health care providers that babies cannot be born through a completely or partially covered cervix.

However, in my research on placenta previa, I ran across this reference to a technique invented by a medical doctor for vaginal birth before c-sections were routinely performed.   This quote was found on a midwife's site:

"I came across the following in "The Accoucheur's Emergency Manual" by Yingling, first published in 1921 in India, at a time and place where cesareans were not readily available.  I think most of us agree that a cesarean section is the preferred approach with placenta previa, but I also think it's important to have this tucked away in the back of your mind, just in case:

In placenta praevia I fully recommend the method or plan of Dr. H. N. Guernsey, which is "in puncturing the membranes through the placenta and evacuating the liquor amnii."  "The finger must explore a sulcus between the cotyledons of the placenta, and with the same hand a female catheter, previously concealed in the palm, must be forced through the placenta and the membranes during a pain." "The liquor amnii must be drawn off slowly: and as surely as it thus flows, so surely will the haemorrhage cease.  After the waters have pretty much escaped, the finger may take the place of the catheter, and aid in tearing the orifice larger, so that the presenting parts may descend."  This method applies whether the placenta is central or only partially over the os uteri.

I've quoted this all in a block, and I'm going to run it down point by point.

Diagnosis of placenta previa does not mean automatic section.  Most cases of previa are diagnosed at mid-pregnancy ultrasound, or when the mother presents at the ER or L&D unit with unexplained vaginal bleeding.  Most of the time, the issue resolves on its own before delivery.

Health care providers believe that babies can't be born through the placenta because historical records of what happens in this situation tell them so.  Diaries and memoirs of midwives and physicians and medical casebooks and textbooks contain vivid descriptions of placenta previa cases.  Older doctors and nurses, particularly those who practiced in underserved or remote areas, have seen it themselves.

In India (as just about everywhere) in 1921, treatment for placenta previa was considered a success if the mother survived.  Like most of the historical techniques for coping with this situation, the one described here is a method for delivering a dead baby.  In treating placenta previa before c-sections became as safe as they are today, the baby was often used as a means of applying pressure to stop the bleeding, and the pressure applied to the baby in the process was usually fatal.  Some of the more effective techniques for applying pressure involved manipulating the infant in ways likely to sever the spinal cord.  (If you want to tell me how dangerous c-sections are today, please don't bother - I'm not saying they're perfect now, I'm saying that they're much, much safer than they were a hundred years ago.) 

This procedure is, basically, an amniotomy performed on a presenting placenta.  Doctors won't do this today - doctors won't perform so much as a manual cervical exam on a previa patient because of the risk of rupturing the blood vessels in the placenta and causing a hemorrhage. 

...[I]n an unassisted birth, the woman will be either alone or with a family member who may or may not be able to help with this.  Using a catheter is asking a lot, and time will be of the essence.  The mother MUST use her intuition to determine when it is the right time to tear the hole, or use muscle testing to determine this.  The birth must be fairly close to taking place.  The mother also must feel fairly certain intuitively that she would not be better off in the hospital.

I am not telling anyone with placenta previa what to do.   Whether you choose to go to the hospital, or choose to stay home, this must be your decision, and you must be sure intuitively of what you are supposed to do.  My experience with the intuition of birthing mothers is that you will get a very strong feeling of what you are supposed to do.  Either you feel that the situation is life and death and that you cannot handle it, or you feel strongly that the situation will resolve itself.  Follow that intuition.  When you feel that the baby is presenting itself and that no further progress can be made unless the placenta is removed from the opening, tear a hole, allow the fluid to empty out, and help guide the membranes around the baby's head, bearing down gently as the contractions direct you.

I'm really glad she's not telling anyone with placenta previa what to do.  I'll step in though:  go to the hospital.  You need to be there.

I quote this section because the way it's written makes me suspect that the writer has never seen a previa case herself.  Snelson assumes that the mother will go into labor, she assumes that there will be contractions.  And she talks about draining out the amniotic fluid as though, if you did it, you'd be able to tell.  She doesn't seem to have any concept of how much blood will be involved - she seems barely aware that there will be blood involved at all.

I need to talk about bleeding, becauseI don't think I can explain how far off base Snelson is without describing the factor she's missing.  We live in a culture that glorifies violence but shies away from realistic depictions of blood and bleeding.  Murder victims in Sunnydale have, at most, an artful crimson trickle someplace (I guess vampires are tidy).  Bones and Booth declare blood to be present "in fatal quantities" every time they find a smear of it.  We define gynecological hemorrhage as enough blood to fill one or two heavy duty menstrual pads in an hour, and I think that sometimes leads us to think that a hemorrhage takes an hour to diagnose, or that hemorrhage is best identified by counting your supplies.  In previa cases, cervical dilation damages the blood vessels in the placenta, leading to very fast, very heavy bleeding.  I only ever dilated to three centimeters, and blood was splashing out of me and onto the floor.  I left puddles of blood behind me.  Pads didn't do a darn thing.  There was no warning.  One moment I was lying in bed reading, the next I was bleeding like a Yakuza in a Tarantino film.  Unstable hemorrhage before term is a pretty common outcome for previa cases, and my unstable hemorrhage wasn't all that bad as these things go - I didn't pass out, and I managed to avoid transfusions.

This kind of bleeding makes the actions Snelson describes impossible.  Wait until the birth is close to taking place?  You would probably bleed to death long before you were fully dilated.  Allow the fluid to empty out?  There'd be so much blood that you could never identify the amniotic fluid if you got to it.  Nor could you ever tell when it had stopped draining.  And these last sentences make it sound like Snelson's suggestions make some kind of sense, which they don't.

THe first rule for dealing with placenta previa - the thing you are most likely to read if you look for it - is DO NOT TOUCH THE CERVIX.  If you were to follow Snelson's advice, and recruit a partner or family member to puncture your placenta, &c., not only would you most likely die, but local law enforcement would be likely to conclude that the partner or family member had murdered you and (depending on the statutes where you live) your baby.  Not only would your family have lost you, but they'd be forced to explain their actions to DAs and medical examiners, and defend themselves for honoring choices that law enforcement will view as irrational. 

You may be thinking...."Why would someone in their right mind stay home if they know or suspect they have this condition?"  Probably because they are aware of the many dangers that await them in the hospital, and how atrocious the American infant mortality statistics are for hospital birth.  Possibly because they have had a previous birth experience that was very traumatic, and they refuse to subject themselves to the dangers of doctors and hospitals.

Hospitals in the US are not the best in the world, but their preinatal mortality rates are fewer than 10 per thousand.  In 1900, JAMA reported a debate between doctors on the proper treatment of placenta previa (here).  In hospitals, maternal mortality rates ranged from 1% to 22.5%.  In rural practice, doctors working in their patients' homes had much worse results.  The lowest fetal mortality I can find in that small print is 15%.  And these numbers are the results for doctors working with careful asepsis, and training and experience in the techniques they used.  Without those factors, the results are worse.

[ElizabethE]

Major Mama-- that link didn't work for me. ??? :(

Jenica, Oh.... I see. Forgive me if I'm making you repeat yourself, but is your partner going to be with you? Because surely the technical things that may be required could be done by someone other than you, if need be? Otherwise, yeah (or even just in case), you'd have to be pretty sure that logistically you could maneuver within the proper quadrants to activate such procedures (haha). You're thinking about if the cord is on the shorter side?

Meepy-- very interesting. Thanks for sharing. These are topics worth exploring more (although the Rh doesn't apply to my particular case). You seem to have some good points there and I would love to see if anyone can validly speak to those from a varying view. Didn't click the link though... sorry! I couldn't tell what it was going to be and I don't typically click on things unless I can. If there is any other way for you to share that info, I would definitely be open to seeing it. If we're going to educate ourselves, it DOES have to be both ways, so again-- I do value your input.

[stik]

MeepyCat's post doesn't contain links.  Some things are underlined or bolded, but no links.  Or did you mean the stuff she spoilered?  It's about management of placenta previa.  The spoilered section is text-only, no pictures, and is safe for work/kids.  Clicking the link reveals the hidden text, and does not take you away from this page.  

[major_mama11]

Oops, sorry about the link not working. It doesn't work for me immediately either.

Try clicking reload? It works for me if I reload the page.

[MeepyCat]

Originally Posted by stik 

MeepyCat's post doesn't contain links.  Some things are underlined or bolded, but no links.  Or did you mean the stuff she spoilered?  It's about management of placenta previa.  The spoilered section is text-only, no pictures, and is safe for work/kids.  Clicking the link reveals the hidden text, and does not take you away from this page.  

Actually, there is one link in the spoilered text - to a JAMA report of a debate on how to best treat placenta previa cases from the early 1900s (can't remember which year right now).  But you can skip right over the link if you want - I linked it to show the source for some numbers, but the numbers are in the text.