Missouri: homebirth has a 20 fold increase in intrapartum death

[claddaghmom]

Didn't see this posted, thought it was relevant to the forum:

http://www.ncbi.nlm.nih.gov/pubmed/21380991

http://skepticalob.blogspot.com/2011/10/missouri-homebirth-has-20-fold-increase.html

[jenrose]

I believe that non-nurse midwifery was illegal in Missouri for the vast majority of the period of time that covers. Any time there's a barrier to transport, home birth becomes more dangerous. And criminalizing non-nurse midwifery creates a HUGE barrier to safe transport.

Here in Oregon, I know that if I want to transport, my midwife won't hesitate. In fact, my entire pregnancy I've been seeing her and getting consults through a perinatologist who both likes and respects my midwife. The hospital has a "Stork Doc" program that designates specific physicians to receive homebirth transports, ones who are not going to make that process harder than it has to be. My midwife isn't afraid that transporting me could lead to her being "caught", because she isn't breaking the law by helping me. 

What this study tells us is that making midwifery illegal is dangerous. It does not tell us that planned home birth is dangerous. 

"Gold standards" of recordkeeping don't help when the infrastructure around homebirth is not supportive. 

[Kelly1101]

Are you sure?
 

Originally Posted by jenrose 

What this study tells us is that making midwifery illegal is dangerous. It does not tell us that planned home birth is dangerous. 

[starrlamia]

multitudes of studies have been done on the safety of homebirth, and unless you are believing the recent wax meta-analysis that is full of mistakes and errors then yes, we can safely say that homebirth for low risk women, is just as safe as hospital birth.
 

Originally Posted by Kelly1101 

Are you sure? 

[Turquesa]

Ummm, not the OP, but she sounded pretty dang sure to me.  Why do you ask? 

Originally Posted by Kelly1101 

Are you sure? 

[Turquesa]

I should add that whenever a baby is born, a provider or other birth certificate applicant fills out one of two applications.  It will be the one from 1989 or 2003.  I'm not sure which one Missouri uses, but neither is sufficient for the research conducted.  Researchers are constantly and erroneously looking to birth certificates for answers, but they do not control for type of provider.  In Missouri, where as JenRose noted midwifery only recently becames legally recognized and licensable, "other midwife" could mean a lot of things.  An actual CPM category would be a useful addition to these applications and give us a better picture of outcomes.  And yes, I'm sure. 

[babycatcher12]

Another thing to consider about statistics is that occasionally there are different reporting rules for CPM then for MDs or CNMs. For example, when a CPM has a patient that transfers and gives birth 24 hours later with a poor outcome...that statistic still goes to the CPM even though she's not providing care in the hospital. Some "rules" about reporting are unclear for CPMs as well. For example, they may record any death that occurs in the first 28 days as a fetal death for their statistics, but if a baby dies within the first 28 days of being born with an MD it doesn't usually get "filed" under their stats. 

[jenrose]

I should also add that gold standards of recordkeeping are meaningless when there are barriers to what actually gets filled out on the forms. 

And yes, I'm sure that studying planned homebirth vs. planned hospital birth in a state during a time when midwifery was illegal tells us very little about the safety of planned homebirth in general.

Just like studies on safety of planned homebirth done in countries with deep infrastructure to support planned homebirth aren't necessarily applicable to "illegal" states.

And I can tell you that what gets reported on birth certificates may or may not actually reflect what really happened in a birth, no matter how good the form is. 

In many studies which had an anti-homebirth slant, they counted all out of hospital births as "midwife" births without necessarily differentiating between CPM, LM, CNM, lay midwife, planned UC or accident "oops the baby came too fast or too early" unplanned homebirths, or car births, or what have you. 

[Buzzbuzz]

"we can safely say that homebirth for low risk women, is just as safe as hospital birth."

I think the more appropriate way of describing it is "homebirth for low risk women who STAY low risk throughout delivery and during the immediate post-partum period is just as safe as hospital birth."  As someone who has had a homebirth, I think you do a disservice to women by pretending that there are not emergent scenarios which may be better handled in a hospital.  As a fan of informed consent, I think a mother should be aware that she runs the risk that her low risk status may change at any point during her pregnancy and delivery. 
 

[babycatcher12]

Originally Posted by Buzzbuzz 

"we can safely say that homebirth for low risk women, is just as safe as hospital birth."

I think the more appropriate way of describing it is "homebirth for low risk women who STAY low risk throughout delivery and during the immediate post-partum period is just as safe as hospital birth."  As someone who has had a homebirth, I think you do a disservice to women by pretending that there are not emergent scenarios which may be better handled in a hospital.  As a fan of informed consent, I think a mother should be aware that she runs the risk that her low risk status may change at any point during her pregnancy and delivery. 
 

I agree with this to a point. The problem is that women are being moved into the "high risk" category for ridiculous reasons, like a history of depression etc. I absolutely agree that there are some situations which should be handled in the hospital. We are responsible for making sure we are informed about our birth options and the risks (however small or great they may be) for the choices we make. 

[Buzzbuzz]

I saw that thread too -- I thought some other posters made good points that it may not be the history of depression that makes her high risk but rather the potential impact of her anti-depressants on the fetus.

I think the problem of high risk women not being risked out by homebirth midwives is certainly the larger issue -- in my experience there are a lot of women out there telling other women what they want to hear.