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Thoughts on "planned home births are associated with double to triple the risk of infant death... - Page 7

post #121 of 394

The document really doesn't provide sources- and that is frustrating.

One can make an assumption that the data was collected from the Oregon Vital Statistics office. We're left to make some assumptions about the .6/1000 hospital rate - because that must exclude many higher risk births.

 

http://public.health.oregon.gov/HealthyPeopleFamilies/DataReports/PerinatalDataBook/Documents/pnch2/neonatalmortality.pdf

 

This document states that OR on a whole has a lower average neonatal mortality rate than the rest of the US. But this number is reported to be 3.8/1000.

 

More detail would be helpful in understanding how those numbers were generated. I agree.

post #122 of 394

IdentityCrisisMama: I can send you the entire 3 page pdf, but she does not have the sources listed. I am in contact with her and can ask if she can provide the raw data or the sources.

 

There are quite a few people who don't like her conclusions or testimony, and are trying to pick it apart. Knowing Judith, I doubt that she missed anything. She is very thorough. I am thinking that she was not pleased with what she found either. She is a huge proponent of midwifery and even says that Oregon needs more DEMs, but that their educational standards, knowledge, and skills need to improve.

 

This is the same thing that has come up in multiple posts throughout this thread. Midwives who are losing babies are those who lack the education, knowledge, skills, and judgement. Home birth is safe, but it is the provider who makes it safe. If she is lacking, care will suffer, and mothers and babies will continue to lose their lives.
 

post #123 of 394

I have posted a note to Ms. Rooks asking if she could supply the source of the material, and the data collection method. I will let you all know when I hear back from her.
 


Edited by mothercat - 3/17/13 at 6:52am
post #124 of 394
Quote:
Originally Posted by mothercat View Post

IdentityCrisisMama: I can send you the entire 3 page pdf, but she does not have the sources listed. I am in contact with her and can ask if she can provide the raw data or the sources.

 

There are quite a few people who don't like her conclusions or testimony, and are trying to pick it apart. Knowing Judith, I doubt that she missed anything. She is very thorough. I am thinking that she was not pleased with what she found either. She is a huge proponent of midwifery and even says that Oregon needs more DEMs, but that their educational standards, knowledge, and skills need to improve.

 

This is the same thing that has come up in multiple posts throughout this thread. Midwives who are losing babies are those who lack the education, knowledge, skills, and judgement. Home birth is safe, but it is the provider who makes it safe. If she is lacking, care will suffer, and mothers and babies will continue to lose their lives.
 

To be clear, I have no problem with her letter or her conclusions and do not wish to pick her apart at all - other than to wonder why she didn't cite sources in her testimony/letter. But I do I wonder how compelling her testimony will be without it. For the record, I think I'm probably fairly conservative when it comes to homebirth advocacy. So, while I sympathize with some of the questions and concerns of those on the more radical end of the spectrum, I tend to agree with Judith's testimony. My point is that we're talking about her testimony and the data she included...it's not picking her apart to wonder where that comes from or how that fits into the bigger picture. 

post #125 of 394

If I remember things correctly I think Ms. Rooks was appointed to this task after the baby's death in  2011 when MANA would not release the data that Oregon requested regarding midwives and newborn deaths in that state. The state decided they needed answers and since Ms. Rooks is a CDC trained epidemiologist and a home birth/midwifery supporter she seemed like a good fit. She had no axe to grind and had a good understanding of the issues involved.

 

BTW: thank you for removing the troll posts. This conversation has remained quite civil and hopefully informative. I was worried it was about to veer off track with those odd postings.


Edited by mothercat - 3/17/13 at 8:06am
post #126 of 394

Posted in error, sorry.

post #127 of 394
She does list her source the birth certificate data---


Twins do represent a clear bit of info and should be removed from the Oregon data when being compared because they surely are removed from the hosptial data- the medical policies on twins is deliver them at 34 weeks...just because they are twins nothing has to be in essence wrong- and because of being born early have a higher chance of dying ..

And this is a 1 year review analysis not really a study- to be clear about that you cannot tell if this is a fluke high or what occurs all the time.

And NOTE she is saying that there is a need for more DEMs , she is advocating for licensure only not for banning home birth.

I would say having lived in Washington state, near to Oregon when it was not a CPM state but had a self crediental that required students to attend 100 births as primary and had other very strict requirements this was not for licensing this is what the midwives organized for their own support and regulation- my impression is that now mostly licensed midwives belong to OMC and that the older more skilled ones still get together for peer review but many are retiring, and because of the liberal views on birth attendants license or no that many midwives have moved there from all over the country who would not follow rules and restrictions in their home states... So there just may be a very renegade crew there now. I too would like to see the stats on seasoned midwives... Mabye even an evaluation of best practices by midwives in general, who knows it may be the younger midwives that have better stats because they transfer sooner, or use dopplers or??? Having lived near there and having my own personal interaction with A midwife who I felt was highly unethical - i could be emotionally swayed to try and blast it all, but i am not going to be stampeeded-
I would also say BUYER beware, a midwife who will agree to do anything or everything at home, no matter what your primary health risks are is probably too good to be true- agreeing to not monitor a baby is not a reasonable agreement either unless you know you are having a stillbirth. continous EMF has not shown to be best but not listening at all is not best either.
The info Judith collected and much more is the kind of info we midwives should be collecting and evaluating ourselves- not waiting for someone else to roll it out of us but taking our stats and evaluating stuff- collectively and timely. Peer review is fine and well and can be timely but is limited to a single situation at a time, how do we do this without becomeing industrialized and too distant from our moms and yet be effective and safe. I have my own pet interests and that I would like to see and that is collecting the numbers on vitamin K administration and on vitamin K related bleeds within the first 6 months after birth but not only bleeds are there any other differences, is there a benefit to not getting vitamin K...
post #128 of 394
So 12 hrs of clinicals in a week sure , students I have worked with could easily get that and if attending births would surpass that in 1-2 months.
Didnt the Yale program when starting out have an 18 month midwife certification, for non- nurses?
So if we were to strip out the " higher learning" and had a direct entry / vocational tech education it could be done in the 3 year schools- remember that the schools are mainly didatic. the majority of the clinical education is seperate from the school instruction.
post #129 of 394

Anything beyond a high school diploma is "higher learning". There is a community college that offers a 2 year midwifery degree. I think it's in Wisconsin.

For anyone who wants to be a Certified Midwife (CM) taking the AMCB national exam, they can complete an 18 month or 2 year program, but those admitted to these program are required to have a Bachelor's degree in a related field or to have other knowledge in health care, such as Paramedics. I will try to find the details on those programs, but I'm sure it's on ACNM's site or on AMCB.

For each of those programs, clinical is integrated into the program, just as it is with other CNM program, campus based or distance learning such as CNEP.

post #130 of 394
Quote:
Originally Posted by mwherbs View Post

And this is a 1 year review analysis not really a study- to be clear about that you cannot tell if this is a fluke high or what occurs all the time.

And NOTE she is saying that there is a need for more DEMs , she is advocating for licensure only not for banning home birth.
 

nod.gif

 

So did she make that graph? From data she collected herself? I'm still a bit confused on the source...

post #131 of 394

mwherbs -- as the mother of twins, and as someone who knows a fair number of twins, I can absolutely and completely assure you there is no medical policy requiring or even suggesting as a good idea delivering twins at 34 weeks as a matter of course.  I carried mine until 37 weeks 5 days.

 

If you are stating that this is ACOG policy or is otherwise endorsed by obstetric professional associations could you please provide a link?
 

post #132 of 394
I know many mothers of twins. Excluding those who developed complications or PTL, I do not know any who were electively delivered at 34 weeks. The earliest I know of was 36. Most are 37-38 for those OBs who believe twins should be delivered slightly earlier than singletons.

Triplets typically go earlier, but this is due to the higher rate of complications.
post #133 of 394

"So if we were to strip out the " higher learning" and had a direct entry / vocational tech education it could be done in the 3 year schools- remember that the schools are mainly didatic. the majority of the clinical education is seperate from the school instruction"

 

You know, barriers to entry are not always a bad thing especially when a job has a high level of responsibility, carries tremendous potential consequences and requires a lot of continuing education/continuing experience to keep skill sets up.  I do have serious questions about the safety of "hobbyist" midwives.

post #134 of 394

"Most are 37-38 for those OBs who believe twins should be delivered slightly earlier than singletons."

 

Which is due to the increasing risk of stillbirth for twins as they move towards 40 weeks.  Later ain't always better.

post #135 of 394
Except that the countries that we point to having lower mortality all along for the last 100 years have been midwife countries with direct entry/ vocational pathways to being a midwife- the out of country midwives I have met for the most part have alot of physical sensibilities ? CNM midwifery is becoming a Doctorate crediental very soon... Do we really believe that it takes a doctorate level education to be a midwife?
post #136 of 394
Here is one article on the subject- i have to say that because of the concern of unknow cause of stillbirth that what I have seen is pretty much standard c-section delivery offered/ done at 34 weeks . http://www.obgynnews.com/index.php?id=11370&type=98&tx_ttnews%5Btt_news%5D=135891&cHash=da03e20e36
post #137 of 394
I looked at the wonder pages to narrow down mortality rates of twins GA born Method of delivery , So western region 07-08 no twin births reported past 37 weeks. The greatest number of births were between 34-36 weeks and a very high death rate for twins over all- total twin births Oregon that year was between 450 and 500 births and the infant mortality rate was 47 / 1000
post #138 of 394

mwherbs, that article is referring to monoamniotic twins being delivered by c section at 34 weeks.  Monoamniotic twins make up less than 1% of all twins, so unlikely to have any effect on the homebirth statistics.
 

post #139 of 394
Quote:
Originally Posted by mwherbs View Post

Here is one article on the subject- i have to say that because of the concern of unknow cause of stillbirth that what I have seen is pretty much standard c-section delivery offered/ done at 34 weeks . http://www.obgynnews.com/index.php?id=11370&type=98&tx_ttnews%5Btt_news%5D=135891&cHash=da03e20e36

That article recommends delivery between 34-37 weeks for monochorionic twins, not for all twins. There's a difference between monochorionic and dichorionic. And also a big difference between 34 weeks and 37 weeks. It would be more accurate to say that 34 weeks is the *earliest* that author recommends delivery for monochorionic twins in the absence of complications (or 32 weeks if they are also monoamniotic). Since this is a thread about homebirth, I think the salient question is which hospital data is being used in the Oregon stats and if the twin gestations are included, what the date cutoff is.

post #140 of 394

There are so many posts on this thread and the topic has seemed to stray a bit.  I haven't seen anyone mention The Farm.  Impeccable, thorough home birth statistics.  These discussions often drive me insane.  We can not compare PLANNED home birth, to those born unplanned; in taxi cabs, on streets, premature, drug addicted, poverty stricken, and unwanted.  Why is it considered a home birth when the prom queen gives birth in the bathroom and tries to flush the baby down the toilet or wraps it in a towel and puts it in the garbage.  This entire study is so flawed.  Planned  babies, born via planned home birth, with skilled attendants = have far better outcomes, as do their mothers than any hospital birth.

 

http://www.thefarmmidwives.org/

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