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Thoughts on "planned home births are associated with double to triple the risk of infant death... - Page 8

post #141 of 394
Quote:
Originally Posted by MidwifeWanda View Post

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/

Which study are you referring to? If it's the Wax study, we already know that. If it's the Oregon testimony, I am still waiting to hear from Ms. Rooks about the data collection and methods. So, we don't have quite enough information yet to saw that one is flawed.

One of the first things we learn about research is that the results apply only to the population involved in the study. You can't take those results and extrapolate them to another midwife, country or community without also replicating all the variables involved. What this means is that if you want to use the Farm midwives' stats to prove safety of OOH birth, then you need to also use their protocol for risking  clients out, you need to have their educational background, the same emergency care needs to be in place. You would also need to replicate the community, their educational background, their diet , lifestyle, and work habits, as well as the community support. 

If any of those things are not exactly the same , then you can't use their numbers to prove that birth is the same just because it is not in hospital. 

post #142 of 394

Midwife Wanda -- did you miss the part in the materials which specifically pulls out the DEM numbers for Oregon midwives?   Planned homebirths attended by Oregon DEMs is what is being analyzed here.

 

Perhaps less bluster and more analysis is called for here. 

post #143 of 394

Rooks makes it clear in her testimony that the data is from planned OOH births.

 

"In 2011 the Oregon House Health Care Committee amended the direct-entry midwifery

—“DEM”—law to require collection of information on planned place of birth and planned birth attendant on fetal -death and live- birth certificates starting in 2012.

 

Oregon now has the most complete, accurate data of any US state on outcomes of births planned to occur in the mother’s home or an out-of-hospital birth center.

 

This table summarizes that data (PTT slide):"

 

Emphasis hers.

 

 https://olis.leg.state.or.us/liz/2013R1/Downloads/CommitteeMeetingDocument/8585

post #144 of 394
When i lived near Oregon one spiritual midwife I knew, only prayed at births-, she would go to the health department and would report the births using the midwife designation, i would guess that even if the laws in Oregon changed to require a license they would not be able to stop her and others like her from attending births.
post #145 of 394
Quote:
Originally Posted by Buzzbuzz View Post

The link emphasizes that this is an analysis of planned homebirths/birth center births and is focused solely on the outcome for term births.

 

What the materials demonstrate very clearly is just how good hospital mortality rates are for term infants.  Also, I find it interesting that she did not specifically call out a line in the table for CNM births.  You can get there simply by subtracting the DEM attended birth information from all the planned homebirth/birth center birth information.

 

When I do that, I get 2 deaths for CNMS out of between 600 and 700 births attended. 

Thanks!

This thread is moving so fast I can't keep up. ;)

 

I am certainly willing to be open-minded, but when all of a sudden one study/review seems to show results that are radically different from what we've seen before, I think it's prudent to ask why.  And when *any* studies are concerned, we have to make sure we're comparing apples to apples (as much as possible). Even if that doesn't change the results, it may change the practical ways those results are applied.  Hence my desire for clarification. :)

post #146 of 394

Here is the reply from Judith Rooks about the testimony she gave and the background. She thinks this should answer any questions, but said she would be happy to answer anything else that comes up. I think this is an especially important point:  neonatal deaths that occur in hospitals after in-labor transfers from OOH settings are no longer attributed to the hospital but are appropriately attributed to the planned OOH birth site.

 


Conversation: Oregon testimony
Subject: Re: Oregon testimony

In 2011 the Oregon Legislature amended the law for licensing and regulating direct-entry midwives (DEMs) in several ways and mandated that information on planned place-of-birth and birth attendant be collected on term fetal death and live birth certificates, allowing creation of data on fetal and neonatal deaths associated with term births in Oregon according to where they were planned to occur.  The data exclude deaths caused by prematurity.  In addition,  neonatal deaths that occur in hospitals after in-labor transfers from OOH settings are no longer attributed to the hospital but are appropriately attributed to the planned OOH birth site.

Oregon now has better data than any other state on OOH birth outcomes, but it is not perfect.  The biggest problem relates to the fetal death component of the data on term births planned.  Fetal deaths (also called stillbirths) can occur antepartum (before labor) or intrapartum (IP, during labor).  Antepartum fetal deaths are much more common than IP fetal deaths.  Extremely few term IP fetal deaths occur in hospitals.  Most fetuses in severe distress are diagnosed by electronic fetal monitoring and delivered by cesarean section.  This saves some babies, while others may die later and be counted as neonatal deaths.  

The big problem now is the data on deaths of term fetuses during births planned to occur in hospitals.  The vital statistics data show 59 fetal demises associated with 39,984 term births planned to occur in Oregon hospitals in 2012, a rate of 1.5/1000 births.  I can’t use those data because the vital statistics system doesn’t distinguish between IP fetal deaths during labor and planned in-hospital deliveries of term fetuses that were known to be dead before the woman went into labor.   Women carrying known-to-be-dead fetuses are commonly admitted to hospitals for induction of labor to get the dead baby delivered as soon as possible in order to protect the mother from hemorrhage caused by disseminated intravascular coagulation (DIC).   I can’t use comparison data that I know to be misleading.  I am trying to figure out how to deal with that problem in the  most truthful way.

I also need a little more information on one of the deaths associated with a birth attended by a “lay midwife” (as per the record).  When I have more information on that case, I will revise the table.  I anticipate that the total (IP fetal + NN) mortality rate for planned OOH births attended by direct-entry midwives will be about 6 times higher than the rate for planned term births in hospitals, or higher.  One of the deaths associated with births attended by DEMs was due at least in part to congenital anomalies.  I calculated the rate both with and without that death but used the lower rate (excluding the death associated with congenital anomalies) when comparing the OOH total mortality rate with the rate for births planned to occur in hospitals, even though the data on planned in-hospital births includes babies with congenital anomalies.

Judith Rooks

 

post #147 of 394
Quote:
Then there are the things that midwives do in the name of "helping the labor along" like giving cytotec or pitocin, in some cases without informing the laboring woman.  All of these were things the midwife thought she could handle at home rather than transferring the woman or her baby to the hospital. If you don't think these things happen, all you need to do is a google search and the women's stories will show up, a lot of them.

 

jaw.gif I must have missed this earlier. They are giving cytotec at home? I had it written in to my hospital birth plan that was in my files that I DO NOT CONSENT to the use of cytotec. I never imagined that that would be something I would have to worry about with choosing a home birth midwife. 

post #148 of 394

It isn't just Dr. Amy's site where you can find these. The moms are writing these stories on their blog posts, in baby center,and other places. There are a lot of them. I finally had to quit reading the stories fruitfulmomma.

 

I have first hand knowledge of a midwife who told the mom she was going to just massage arnica oil into a swollen cervix. She did that, but had also crushed up a cytotec tablet and massaged that in at the same time. She was rather proud of herself when the mom went from a very stuck 6 cms to complete. Not so much so when the baby died after an 8 minute shoulder dystocia.

Yes, you would think that home birth midwives would all be sticking to the same criteria to risk women out, to transfer moms and babies, etc., but very sadly, even though they say they will do these things, some of them don't. Moms and babies die because of it.

 

The standard should be "no identifiable risk factors" during pregnancy, labor, birth, and for the newborn.
 

post #149 of 394
Quote:
erigeron: breech should also be considered a high risk condition. It is one of the conditions that Oregon is considering restricting for home birth midwives. (See the first link in my post above)

 

The problem with restricting breech at home is that many hospitals don't allow breech birth, which forces women into unwanted C-sections. If women could have their breech baby vaginally in the hospital, probably most of them wouldn't be doing it at home.

post #150 of 394
Quote:
the medical policies on twins is deliver them at 34 weeks.

 

mwherbs, can you cite a source for that? Both of the twin births I attended as a doula were at 36 weeks, one induced because mom developed pre-eclampsia and one mom went into labor on her own.

 

 

Quote:
When i lived near Oregon one spiritual midwife I knew, only prayed at births-, she would go to the health department and would report the births using the midwife designation, i would guess that even if the laws in Oregon changed to require a license they would not be able to stop her and others like her from attending births.

 

I wish that those women wouldn't call themselves midwives. This was brought up at the healthcare committee hearing. If someone isn't working within the standards of care/scope of practice for a midwife, they should be using a different title.

post #151 of 394

In Ontario twin births are usually allowed to go to the normal 40 weeks (I could be wrong, but I've never heard of anyone here delivering twins at 34 weeks).

post #152 of 394

Here is the link to the Wisconsin program:

 

http://www.swtc.edu/gray_career.aspx?id=2238

 

I would certainly be willing to take the course if it were local. 

 

After looking at the school's website, I emailed our local community college to ask that they consider starting a Direct-Entry Midwifery program.

post #153 of 394
Quote:
Originally Posted by mwherbs View Post

When i lived near Oregon one spiritual midwife I knew, only prayed at births-, she would go to the health department and would report the births using the midwife designation, i would guess that even if the laws in Oregon changed to require a license they would not be able to stop her and others like her from attending births.

I would guess that Brenda Passion Capps would argue that point with you. And the State of Oregon might too. I would imagine she wouldn't be as effective if she were in jail.  Why would you advocate for this type of care? Or are you just stirring the pot?

post #154 of 394
Quote:
Originally Posted by phathui5 View Post

 

The problem with restricting breech at home is that many hospitals don't allow breech birth, which forces women into unwanted C-sections. If women could have their breech baby vaginally in the hospital, probably most of them wouldn't be doing it at home.


 From the baby's point of view, is that a good enough reason?

 

I know a couple of women in the last 18 months  who thought their midwife was experienced enough and that they understood the risks. One almost lost the baby and  the other two had babies that died. All of these women now say that there are things far worse than a C/sec for themselves when it comes to whether their baby died or was permanently injured.

 

It still comes back to the knowledge and skills of the provider. There are specific guidelines to follow when attempting a breech birth. Guidelines that include when a midwife has enough education, hands on training with a skilled provider, and the  judgement to do a vag breech safely. If the midwives made full disclosure about these things and had a written informed consent detailing when and when not to attempt a breech including the specific risks. Someone other than the midwife should be the person to review and approve the consent so there was objectivity in the information provided.

post #155 of 394
Quote:
Originally Posted by mothercat View Post


 From the baby's point of view, is that a good enough reason?

 

I know a couple of women in the last 18 months  who thought their midwife was experienced enough and that they understood the risks. One almost lost the baby and  the other two had babies that died. All of these women now say that there are things far worse than a C/sec for themselves when it comes to whether their baby died or was permanently injured.

 

It still comes back to the knowledge and skills of the provider. There are specific guidelines to follow when attempting a breech birth. Guidelines that include when a midwife has enough education, hands on training with a skilled provider, and the  judgement to do a vag breech safely. If the midwives made full disclosure about these things and had a written informed consent detailing when and when not to attempt a breech including the specific risks. Someone other than the midwife should be the person to review and approve the consent so there was objectivity in the information provided.

 

It's not a matter of whether it's a good enough reason or not, it's simply part of the long list of things that are seriously wrong with maternity "care".  Women are being forced to make choices that they shouldn't have to make.  Ideally, doctors should have training in how to assist women having a vaginal breach birth, so that women have the option of doing that in hospital, and midwives should also have that training (occasionally babies turn breach at  the last minute, so they should be prepared whether they plan for it or not), and there should be proper informed consent about training and all that.  When you force women to choose between unnecessary abdominal surgery or a homebirth with a provider with questionable skills, it simply sucks. 

post #156 of 394
Quote:
Originally Posted by mothercat View Post
From the baby's point of view, is that a good enough reason?

 

I know a couple of women in the last 18 months  who thought their midwife was experienced enough and that they understood the risks. One almost lost the baby and  the other two had babies that died. All of these women now say that there are things far worse than a C/sec for themselves when it comes to whether their baby died or was permanently injured.

 

It still comes back to the knowledge and skills of the provider. There are specific guidelines to follow when attempting a breech birth. Guidelines that include when a midwife has enough education, hands on training with a skilled provider, and the  judgement to do a vag breech safely. If the midwives made full disclosure about these things and had a written informed consent detailing when and when not to attempt a breech including the specific risks. Someone other than the midwife should be the person to review and approve the consent so there was objectivity in the information provided.

I was a breech baby born via c-section, because I was breech.  Now, I don't know that it's possible for someone to say they wish they'd died instead, but I do wish that I had not been born via c-section.  C section birth results in different gut bacteria.  My gut has never been right & my children have suffered for it (because even though they were all born vaginally & breastfed, I passed on my bad stuff to them).  I believe that the c-section birth resulted in a lack of connection between my mother & I that has been the downfall for our relationship.  It doesn't matter what you do to someone you aren't connected to, or so she seems to believe.  Perhaps I would have been nursed had I not been born that way.  Who knows?  But again, since c-section makes breastfeeding more difficult & less likely to happen, it was likely a factor.  

 

In addition to a decision as to whether a baby should be delivered via c-section or vaginally because of presentation, the potential effects on future pregnancies & deliveries need to be considered, as a part of the informed consent.  In an environment of few if any VBACs, I think the future ramifications should be weighed more heavily.  If/when VBACs are more the norm, then I think it could be considered less heavily.  My brother, my mother's 2nd & last child, was born via c-section, because her first baby was born that way.  He too has a messed up gut & also has mental illness as a result of his unhealthy gut.  (I realize my ideas about gut health are not mainstream.  I'm okay w/ it & it comes from years of research so I am completely comfortable w/ what I am stating here.)

 

I'm responding because you asked about things from the baby's perspective.  I do not intend to minimize the experience of the mothers you are speaking of.  I can not imagine what it must be like to be in their shoes.  I should also say that I do not believe that all babies were meant to be born & live.  Animals just don't work that way.  I'm not one for saving every baby & person regardless of the cost to the individual & those around then.  I have never experienced a loss so saying this is easier for me than someone who has.  candle.gif

 

Sus

post #157 of 394

"vital statistics data show 59 fetal demises associated with 39,984 term births planned to occur in Oregon hospitals in 2012, a rate of 1.5/1000 births." 

 

So basically, even when you include death prior to labor (the most common type of infant death) per Ms. Rooks above) in the hospital numbers and exclude it from the DEM numbers, hospital birth is more than three times safer than birth with a DEM.

 

Perhaps I have a suspicious mind, but I have to believe that MANA, through its MANAstats program, has had knowledge of this situation for a while.  

 

Honestly, I think the Oregon legislature should require that these numbers be included in the informed consent document midwives need to provide to their clients.

post #158 of 394
Quote:
Originally Posted by mama24-7 View Post

I was a breech baby born via c-section, because I was breech.  Now, I don't know that it's possible for someone to say they wish they'd died instead, but I do wish that I had not been born via c-section.  C section birth results in different gut bacteria.  My gut has never been right & my children have suffered for it (because even though they were all born vaginally & breastfed, I passed on my bad stuff to them).  I believe that the c-section birth resulted in a lack of connection between my mother & I that has been the downfall for our relationship.  It doesn't matter what you do to someone you aren't connected to, or so she seems to believe.  Perhaps I would have been nursed had I not been born that way.  Who knows?  But again, since c-section makes breastfeeding more difficult & less likely to happen, it was likely a factor.  

 

In addition to a decision as to whether a baby should be delivered via c-section or vaginally because of presentation, the potential effects on future pregnancies & deliveries need to be considered, as a part of the informed consent.  In an environment of few if any VBACs, I think the future ramifications should be weighed more heavily.  If/when VBACs are more the norm, then I think it could be considered less heavily.  My brother, my mother's 2nd & last child, was born via c-section, because her first baby was born that way.  He too has a messed up gut & also has mental illness as a result of his unhealthy gut.  (I realize my ideas about gut health are not mainstream.  I'm okay w/ it & it comes from years of research so I am completely comfortable w/ what I am stating here.)

 

I'm responding because you asked about things from the baby's perspective.  I do not intend to minimize the experience of the mothers you are speaking of.  I can not imagine what it must be like to be in their shoes.  I should also say that I do not believe that all babies were meant to be born & live.  Animals just don't work that way.  I'm not one for saving every baby & person regardless of the cost to the individual & those around then.  I have never experienced a loss so saying this is easier for me than someone who has.  candle.gif

 

Sus

My son was born via pre-labor elective c-section and is also part of a study which studies elective c-sections of healthy pregnancies and babies. He was found to have escherichia-shigella present. The most recent "study" which concluded that c-section babies do not have this bacteria studied only 4 babies from the same hospital born via c-section. 

I found no difficulties whatsoever with breastfeeding (I'm 5 feet tall, my baby was in the 85th percentile for height and weight) and still he was nowhere near my incision to make it even the slightest bit painful.

I'm not peddling c-sections or advocating for them, and I know it's anecdotal evidence but I don't like when women are made to feel guilty or responsible if their child is of less than perfect health. 

Because of my experience, no one will ever be able to convince me that if a child has asthma, bowel disorders, learning disabilities, etc. that it can be unequivocally blamed on the c-section. 

Also anecdotal, I found out after my son was born that my mother had me 100% natural and breastfed me (I knew she breastfed me but never that I was born naturally), we have almost zero emotional connection; I almost feel bad that she went to all that trouble. After I had a baby I kind of felt we had something in common (must have been the pregnancy hormones) but that passed. 

Throughout my entire life I've always had an emotional connection with my dad and he wasn't even in the same town when I was born, and I'm fairly certain he never breastfed me wink1.gif

post #159 of 394
Quote:
Originally Posted by Escaping View Post

My son was born via pre-labor elective c-section and is also part of a study which studies elective c-sections of healthy pregnancies and babies. He was found to have escherichia-shigella present. The most recent "study" which concluded that c-section babies do not have this bacteria studied only 4 babies from the same hospital born via c-section. 

I found no difficulties whatsoever with breastfeeding (I'm 5 feet tall, my baby was in the 85th percentile for height and weight) and still he was nowhere near my incision to make it even the slightest bit painful.

I'm not peddling c-sections or advocating for them, and I know it's anecdotal evidence but I don't like when women are made to feel guilty or responsible if their child is of less than perfect health. 

Because of my experience, no one will ever be able to convince me that if a child has asthma, bowel disorders, learning disabilities, etc. that it can be unequivocally blamed on the c-section. 

Also anecdotal, I found out after my son was born that my mother had me 100% natural and breastfed me (I knew she breastfed me but never that I was born naturally), we have almost zero emotional connection; I almost feel bad that she went to all that trouble. After I had a baby I kind of felt we had something in common (must have been the pregnancy hormones) but that passed. 

Throughout my entire life I've always had an emotional connection with my dad and he wasn't even in the same town when I was born, and I'm fairly certain he never breastfed me wink1.gif

Did you see that I was responding to the person who asked for the perspective from a c-section baby?  Maybe your son will feel differently than you do?  How could the original question I was responding to be answered any other way than anecdotally?

 

Personally, I don't need studies of any kind to tell *me* that vaginal birth is the normal, preferable birth route.  If it wasn't, we'd have an exit out our abdomens.  That's great that you are a part of a study.  It'll be interesting to read the findings.  Studies don't mean much to me though.

 

What did I say that *made* you or any other mother feel guilty?  What did I say that *made* you or any other mother feel responsible for less than perfect health of your/their child?  I was relating my experience & anyone who chooses to feel guilt or any other feeling is taking *my experience* personally.  It's not about anyone else but me.  I will not be held responsible for the feelings of others.  I can not *make* anyone feel any emotion whatsoever.

 

Sus

post #160 of 394

When a thread veers into the hypothetical, the anecdotal and when negative assumptions are made a tread can quickly turn hostile and unproductive.  Members please be aware of where you are posting - this is the homebirth forum of a natural family living website. Here is a segment of the UA to keep in mind as we move forward: 

Quote:
Mothering aims to be a welcoming environment to discuss subjects pertaining to and surrounding natural family living. We appreciate that members come to our community at different places in their parenting journey and one of our goals is to welcome and educate new members. With that in mind, we expect our members to keep conversations civil and on topic, and uphold the integrity and diversity of the community. We value the honest and supportive exchange of ideas and opinions, and we ask that members avoid negative characterizations and generalizations about others.
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