Thoughts on "planned home births are associated with double to triple the risk of infant death... - Page 9

[Buzzbuzz]

"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."

You seem to have no difficulty posting on the internet.  Not sure how "normal" that is. Maybe you've flown someplace a time or two?  Not normal - if people were "meant" to fly, they would have been given wings, right?  

I find it frustrating that somehow only birth must be performed as it was prehistorically to be done "right".

"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."

Happily, humans have a unique ability to substantially improve their environment and lives.  That some babies are "meant" to die is a terrible justification for not dealing with the substantially higher rate of infant death that we are seeing with the inadequately trained DEMs in Oregon.  There IS a difference in outcomes based on care providers.  It has been demonstrated and those term infants were NOT "meant" to die.  How hurtful to their mothers to simply shrug your shoulders and claim that there was nothing to be done.   

[IdentityCrisisMama]

Originally Posted by Buzzbuzz 

How hurtful to their mothers to simply shrug your shoulders and claim that there was nothing to be done.   

I posted right above this response because I could see this topic headed in this this direction. It's really a little too far OT, IMO, and is a VERY difficult conversation to have anyway.  

I'm not talking to anyone in particular, BTW!  

MDC welcomes some of these tough conversations but in order for us to have them in a productive way, there has to be some level of respect and understanding first. That is why we have these different forums so that like-minded people can discuss hard issues. It is also why we ask members to make positive assumptions. When in doubt, PLEASE assume that the member is talking about themselves and their personal values and choices that the would make for their family.  Understand that making a personal choice IS NOT a criticism of whatever choice you are making. 

If you are unclear, ask for clarification in a genuine, open way. This way the dialog can expand and help us all learn from each other. 

[IdentityCrisisMama]

Originally Posted by rachelsmama 

When you force women to choose between unnecessary abdominal surgery or a homebirth with a provider with questionable skills, it simply sucks. 

This!  

I'm still having trouble understanding how to get my head around the letter from the Oregon MW or what it is even...now it appears to be her own collection of birth stats that she is crunching herself?  Not to be a naysayer, but does she have the educational background to qualify her to do that?  The whole thing still confuses me. What the Oregon study tells me is more than anything we can not apply stats from one system to our own, and that states and regions in the US have very different birth cultures and climates for HB.  

One thing that I question is whether it doesn't make sense for some of the transfer outcomes to be listed under hospital birth. Like someone said above, most hospital transfers are non-emergent. If a child started at home, transferred for pain medication, why would the outcome be listed under HB?  Some of this just doesn't sit well with my view of things, which involves making the most of what all birth options have going for them. 

[Escaping]

Originally Posted by mama24-7 

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

I didn't say you made me feel guilty, I was attempting to be reassuring to you and your mother. Sorry you seem to have taken it another way.

[fruitfulmomma]

Not to be a naysayer, but does she have the educational background to qualify her to do that?

From post #117...

I’m a certified nurse-midwife, a past-president of the American College of Nurse-Midwives, and a CDC-trained epidemiologist who has published three major studies of out-of-hospital births in this country.

[IdentityCrisisMama]

Oh, good...well, then I will read with more interest when her study is published!  I've never seen info presented like this before so it has my suspicions up. 

[AlexisT]

I don't know if it's a "study" that will be published in that way. Oregon midwives refused to provide the data themselves, so Rooks was hired to provide it, AIUI. Apparently, MANA refuses to provide data on the grounds that it may be used against home birth midwives and they believe the data should only be used to benefit them. 

Also, the outcomes were listed as PLANNED place of birth. Most studies do it this way, to account for transfers skewing the results. Otherwise, a problem that had begun at home would be falsely attributed as a hospital birth. Births move from home to hospital, but not from hospital to home, as a rule. 

[Buzzbuzz]

"Oh, good...well, then I will read with more interest when her study is published! I've never seen info presented like this before so it has my suspicions up."

My understanding is that Ms. Rooks was hired by the state to analyze the results of the data that they, in 2011, required be included in the birth and death records for the State of Oregon.  As others mention, this was due to the fact that MANA and, more specifically, Melissa Cheyney, was not willing to share the Oregon MANA results with the State.   Her report is not due until June, but she provided this testimony as to her results because the legislature is currently discussing whether to change the state midwifery law.  Obviously, she felt the results were significant and urgent enough that they could not be delayed until the full report was ready and available.

This link provides a good summary of the current status of the legislative process in Oregon.

http://www.thelundreport.org/resource/house_bill_requires_midwives_to_be_licensed_in_oregon

I would not consider the licensing requirements, as described, to be stringent.  If this passes, it will be interesting to see if what they are requiring will be sufficient to actually improve outcomes.

Edited by Buzzbuzz - 3/19/13 at 11:38am

[mama24-7]

Originally Posted by mama24-7 

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

I've quoted myself above because I'm being quoted out of context of what I've said.

Originally Posted by Buzzbuzz 

"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."

You seem to have no difficulty posting on the internet.  Not sure how "normal" that is. Maybe you've flown someplace a time or two?  Not normal - if people were "meant" to fly, they would have been given wings, right?  

The risks from those things are ones I'm willing to take.  The benefit of them is worth the possible downfall.  There are probably millions of examples.  Knowing what I know, having experienced what I've experienced, I'm comfortable posting on the internet but not comfortable having a c-section for breech presentation only.  

Quote:

Originally Posted by Buzzbuzz 
I find it frustrating that somehow only birth must be performed as it was prehistorically to be done "right".

Perhaps if you've experienced what I have, you would lean towards more "right."  No where did I say it was wrong.  It was not right though, for me.

Quote:

Originally Posted by Buzzbuzz 
"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."

Happily, humans have a unique ability to substantially improve their environment and lives.  That some babies are "meant" to die is a terrible justification for not dealing with the substantially higher rate of infant death that we are seeing with the inadequately trained DEMs in Oregon.  There IS a difference in outcomes based on care providers.  It has been demonstrated and those term infants were NOT "meant" to die.  How hurtful to their mothers to simply shrug your shoulders and claim that there was nothing to be done.   

Yes, my life is an improvement over death.  However, I'm not the kind of person who feels like "survival" is the goal I want to meet.  C-section was the first of many strikes against me & I won't sit on my typing fingers while people post asking about how c-section babies might feel just because it makes someone uncomfortable.

Where did I say this or anything like it: That some babies are "meant" to die is a terrible justification for not dealing with the substantially higher rate of infant death that we are seeing with the inadequately trained DEMs in Oregon  I believe I said in a previous post that I did believe more education & training (maybe something else or different than this) would likely result in better outcomes.

You took that sentence away from the rest of what I said.  You can try to turn me into a cold, heartless, careless person if you want, but I'm not.  

Originally Posted by Escaping 

I didn't say you made me feel guilty, I was attempting to be reassuring to you and your mother. Sorry you seem to have taken it another way.

Oh, thanks for clarifying.  No, I didn't get the reassuring part.   It is not the only strike against her & me, but I think about how I feel so connected & loving towards my children & about how I doubt my mother has ever felt it.  One of the things I think contributes to that is how my body reacted (chemically) to each birth.  We're supposed to be connected to our offspring.  Survival, you know .  Yes, there were other factors, but birth was one of them, a big one, I believe.

Sus

[IdentityCrisisMama]

Originally Posted by Buzzbuzz 

This link provides a good summary of the current status of the legislative process in Oregon.

http://www.thelundreport.org/resource/house_bill_requires_midwives_to_be_licensed_in_oregon

I would not consider the licensing requirements, as described, to be stringent.  If this passes, it will be interesting to see if what they are requiring will be sufficient to actually improve outcomes.

Yea, that's a better article and explains more of what's going on in Oregon. I'm surprised myself by the argument of the opposition listed in the article. If that's all they got, I agree that its pretty weak.I think this is an interesting topic, for sure, but wonder how well it is applied to the general question of the safety of home birth. I get that it's related but now agree with that long ago opinion that this is a topic on its own.  

[Katie8681]

I was born via c/s for breech position. I am so very grateful to my mom for undergoing surgery so that I had a better chance at a healthy, neurologically intact life. Being breech in utero is hard enough! I had hip dysplasia that had me in a brace for the first 6 months. I feel very lucky to be a "walky-talky". So there's my take on it.

[IdentityCrisisMama]

I see so much of this as related - in the HB midwifery model of care, I feel like (often) we talk about optimal positioning and what a mother can do throughout pregnancy to encourage that. Can this happen in the care of an OB or hospital birth MW, yes, of course. Can a HB baby come breech even with the attention to optimal positioning, yes. But, it's the overall model of care that I think needs preserving, like I said up thread, because I think HB practices can have a positive impact on all births. It's not fair, IMO, to take from what has been preserved and call that obstetrics without recognizing the value of its origin. We talk about what's easily understood and measurable a lot and I think that's important but my mind goes off to things that aren't and things that are more intertwined in other things. Katie, you are a CNM, and you had hip dysplasia as a result (you think) of being breech. Do you, now employ some measures to ensure optimal positioning? Do you ever feel or wonder if the option of c-section mean that doctors are less focused on things like that? Or that there is less folk-wisdom and advice about those things? And at a cost? For me HB had more to do with making sure that I attended to all of that first so that I knew that if I needed medical care for my birth, that it was really needed. If that makes sense... 
 

[Buzzbuzz]

 "If that's all they got, I agree that its pretty weak."

I believe that very few midwifery advocates are speaking against the bill because of the very large carrot at the end of the process.  I think the midwifery community in Oregon has largely accepted that eligibility for insurance reimbursements are not going to happen without mandatory licensing.  Since the licensing requirements in the bill are very minimal and the potential benefit (insurance reimbursements) is large this may make a lot of sense for the average midwife in Oregon.  I wish the midwife community was, as a whole, coming at licensing out of a safety concern rather than a reimbursement concern, but I guess what matters in the end are results rather than intentions.

"One of the things I think contributes to that is how my body reacted (chemically) to each birth."

I'm sorry, but I think the "only vaginally born babies are REALLY loved by and attached to" their mothers meme is just so unfortunate.  There is absolutely no, no, NO studies, reliable scientific evidence or any proof that this is true.  I feel so bad for the mothers who believe it and end up needing a c-section.  Just imagine the pain of believing that your relationship with your child will be poor, that your love for your child is somehow inferior and that you have failed right out of the starting gate.  And all that pain based on some wild theory advanced by a natural childbirth advocate who has no evidence to back it up.

Talk about adding even more pressure to new mothers...http://www.slate.com/blogs/xx_factor/2013/03/19/cynthia_wachenheim_s_suicide_shows_us_that_new_mothers_can_be_vulnerable.html

[IdentityCrisisMama]

Originally Posted by Buzzbuzz 

I'm sorry, but I think the "only vaginally born babies are REALLY loved by and attached to" their mothers meme is just so unfortunate. 

Please, I have asked twice to move past this. No one here said this. Period. This line of discussion will lead down the road where we are debating the likely merits of unmedicated childbirth on the homebirth forum of a natural family living website...on a thread about a specific study that is already way off track. 

If you wish to discuss the research into infant/maternal bonding after various birth scenarios (and there IS a lot to discuss on this topic!), we have an entire pregnancy board where that can be discussed with a huge variety of parents and birth choices. 

[erigeron]

nm... sigh.

[mothercat]

IdentityCrisisMama, to answer your question about Judith Rooks. She is a former president of ACNM, a CNM who is a huge supporter of home birth, she has a PhD, and in addition to a whole slew of articles and studies including the first "safety of birth centers" studies in the 1990s, she also wrote the book "Midwifery in America".

Her current project is working to bring Entonox (Nitrous oxide and oxygen in a 50/50 mix) back to hospitals and into birth centers so that women have more options for pain relief during labor than Nubain or an epidural. She has been partly successful with the Entonox project because there are now more than a dozen hospitals that have reintroduced nitrous to their labor wards.

[IdentityCrisisMama]

Originally Posted by mothercat 

IdentityCrisisMama, to answer your question about Judith Rooks. 

Thanks MC. Please send her my regards and if she is aware of my questions, let her know that it was just the way her document was presented that had me wondering.  I'm sure she's getting it from both ends with the Oregon testimony. I think she's doing midwifery a great service with her investigation, activism and concern.   

[Buzzbuzz]

"on a thread about a specific study that is already way off track."

Maybe we keep getting diverted because there is very little real data on the homebirth safety point.  Rooks states that the Oregon data is some of the best available in the US.

So for discussing homebirth safety within the United States we are left with:

Johnson & Daviss -- which has been heavily critiqued.

Wax -- which has been heavily critiqued.

Rooks -- the very new Oregon numbers, report not yet published

CDC Wonder numbers -- use of which can be problematic, whether you are looking at the pro or con side, given the nature of the information available and how you can sort it.

MANAstats -- which MANA refuses to release as to mortality.

Anything else I'm missing here?

[mothercat]

Other US studies for OOH birth: although not specifically home birth,  are the two birth center studies. In the PDR data set, and the former UDS data set that American Association of Birth Centers uses, the data entry person is asked to specify at initial visit where the client intends to birth. The issue is revisited in the third trimester, and can be noted as different at that point. However, the change must be explained. The midwife is not allowed to go back to the initial visit question, as that data in locked after the section is completed.

These studies are prospective which means that once the client is entered in the database, the midwife must explain the pregnancy outcome. This applies to home birth, because many of these birth centers also do home birth, so one could surmise that the risk criteria, care and outcomes would essentially be the same for clients choosing both home and birth center.  There has been an issue that this may not be completely true. I have seen a couple of posts on blogs like EvidenceBasedBirth where midwives and other birth workers cite first hand knowledge that some of the midwives will "risk out" a woman planning a birth center birth, but then do a home birth for her. The cases cited include VBAC, breech, twins, health and pregnancy issues.

Susan Stapleton who was the lead author on that study, is also the president of the Center for Accreditation of Birth Centers. She is aware of these reports and is now taking a second look at the data entry to suss out whether this small number of reports would have any statistical significance on the overall results. OTOH, Susan is also very ethical and knows that if the midwives who operate these centers are doing this to "massage" their numbers, it will affect the overall credibility of an otherwise well done study.

[mothercat]

BTW: the Johnson and Davis study also included some Canadian midwives, so not completely a US data set.