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Thoughts on "planned home births are associated with double to triple the risk of infant death... - Page 12

post #221 of 394
Coming in late but...I know that other times, underground midwives and even non-midwife birth attendants end up as "Other Midwife." that's why there needs to be one specifically for CPMs. "Other midwife" is too broad and vague and doesn't allow CDC Wonder to control for the CPM credential. I have no clue how that would change the outcome for the data, but wouldn't it be nice to find out?
post #222 of 394

I thought this was a bit interesting.  Colorado requires its midwives to report homebirth outcomes.  In its discussion of their outcomes, the state midwifery association notes:

 

"Based on numerous studies already published comparing home and hospital births, it’s clear that two deaths in 600 or 700 births are not outside expected outcomes for planned homebirth of healthy low-risk women and babies attended by trained direct-entry midwives."

 

http://www.coloradomidwives.org/about/about-homebirth/45

 

It's a fascinating approach.  Its almost like they are saying, yes our numbers our crappy, but everyone else's are too, so that's just fine!   It's a whole disclosure about safety rendered essentially meaningless without the comparison to hospital birth.  

 

 

post #223 of 394

I still like Dr. Paneth's comment at the IOM  conference in early March that there are 3 sentinel events we should never see at a planned home birth.

 

Maternal death

Intrapartum neonatal death

Newborn death
 

We need birth certificates to track this information.

post #224 of 394
Quote:
Originally Posted by mothercat View Post

I still like Dr. Paneth's comment at the IOM  conference in early March that there are 3 sentinel events we should never see at a planned home birth.

 

Maternal death

Intrapartum neonatal death

Newborn death
 

We need birth certificates to track this information.

 

I watched his presentation, MC, and will admit my ignorance that I really don't understand this comment. Can you expand on this a little? 

post #225 of 394

Dr. Paneth is a biostatician, and epidemiologist. He works with birth certificates. From a public health and policy perspective he feels that we don't have a clear picture of birth outcomes and that there needs to be more information on birth certificates.

It goes back to what happened in Oregon and Judith Rooks testimony. The home birth deaths occurred in a year when the intended place of birth vs. the actual place of birth were not listed on the birth certificate. The Oregon Department of Health felt that they needed to know if deaths that occurred in the hospital were births that had been intended for home but transferred in because of complications. There was no way to suss that information out and MANA stats would not release the information they had that would have clarified the issue. Oregon decided to change the birth certificate to require this information and a year's worth of the updated birth certificates was used for Rooks' testimony. Thirty one states now have this on the birth certificate. in states where the information is NOT listed, the death is listed in the hospital mortality rates, rather than with the OOH midwife who was making decisions before the transfer.

 

Dr. Paneth wants this info on all birth certificates. It will then let policy makers and the public have a better understanding of the safety of birth in a specific hospital or OOH setting. His point is that a maternal or fetal/newborn death is extremely rare in hospital for low risk women and from the limited data we have, such as Rooks' research and testimony, it would appear that the OOH death rate in some areas is higher than should be seen if midwives are appropriately educated, skilled, proficient, and caring only for women with the same low risk. In matched populations for risk (no identifiable risk factors), the maternal and fetal/newborn death rates should be the same.
 

post #226 of 394

"In matched populations for risk (no identifiable risk factors), the maternal and fetal/newborn death rates should be the same."

 

I don't see how that can be true.  Won't OOH birth always have a slightly higher maternal/fetal/newborn death rate even in matched populations?  Because there are always women without identifiable risk factors who will still have things occur to them, right?   And some of those instances are survivable in a hospital but are not survivable OOH (for example AFE).

 

Or are you assuming that all potential risks are always identifiable if you just look/test/scan "hard enough"?

post #227 of 394
I think it only gives part of the picture, what if a vbac mom intends to give birth at home but at say 20 weeks she if found to have complete previa- and is followed ever after by the docs, and she has an abruption and a late loss . Her intent early in pregnancy was home but with a complete previa that stayed so near term.
There are additional confounders to this plan as well such as people who transfer care but refuse to cooperate with medical recommendations, recommendations a midwife would agree with- is this really homebirth atributable does it really solve anything or give enough information to help change things or to know what could be done differently or better or does it just serve to point out how bad homebirth is----
With one the cause of all the problems was NOT mother's initally intended birth place and everything to do with her previous medical care , are we then going to have birth certificate information that can track that info and assign blame-
post #228 of 394

So the question would be, how is the intention as to where to give birth quantified? If someone intended a HB up until week 20 and then planned a c/s, I would think that the later intention would be what showed up on the birth/death certificate. Without any substantiation either way as to how this is measured, you're just speculating. 

post #229 of 394

The study will usually say something about that--I know one NHS study used intended place of birth at time of booking but then separated out antepartum transfer from intrapartum. So your placenta previa, etc would be in group 1. Or a case like this might be completely excluded because it would eliminate women with certain risk factors. 

 

ETA: here is info on the NHS Birthplace study--which included only low risk births and excluded women with known risk factors:

http://www.nhs.uk/news/2011/11November/Pages/hospital-births-home-births-compared.aspx

post #230 of 394
Quote:
Originally Posted by Buzzbuzz View Post

"In matched populations for risk (no identifiable risk factors), the maternal and fetal/newborn death rates should be the same."

 

I don't see how that can be true.  Won't OOH birth always have a slightly higher maternal/fetal/newborn death rate even in matched populations?  Because there are always women without identifiable risk factors who will still have things occur to them, right?   And some of those instances are survivable in a hospital but are not survivable OOH (for example AFE).

 

I would not assume that. 

post #231 of 394
Quote:
Originally Posted by Buzzbuzz View Post

"In matched populations for risk (no identifiable risk factors), the maternal and fetal/newborn death rates should be the same."

 

I don't see how that can be true.  Won't OOH birth always have a slightly higher maternal/fetal/newborn death rate even in matched populations?  Because there are always women without identifiable risk factors who will still have things occur to them, right?   And some of those instances are survivable in a hospital but are not survivable OOH (for example AFE).

 

      This is the same reasoning the hospital uses for why all women should birth in hospital. That, for the most par,t they are dealing with a population that is 85% low risk (no identifiable risk factors at the onset of labor), yet things can suddenly go wrong. Dr. Paneth's point may be (I won't try to speak for him), that if midwives are dealing only with women who are in the lowest risk category, and they have the knowledge, education, skills, and proficiency to risk women out who begin to develop complications before and during labor, then it should be extremely rare to see the number of deaths of mothers and babies that we are beginning to see in OOH birth.

 

Quote:
Originally Posted by erigeron View Post

So the question would be, how is the intention as to where to give birth quantified? If someone intended a HB up until week 20 and then planned a c/s, I would think that the later intention would be what showed up on the birth/death certificate. Without any substantiation either way as to how this is measured, you're just speculating. 

 

For the birth certificate, it would be intrapartum only. The intended place of birth earlier in pregnancy wouldn't matter as that is much less likely to impact the birth itself.

 

So, if a woman began labor and had planned to birth at home, check the box for that. If she started out labor planning a hospital birth, then check that. I know that Ohio has a box which specifically asked about place of birth and home is listed as an option. However, it is further broken down to ask intended or unintended. They also include a box for a baby born en route to the hospital.

 

I know there is a section on Ohio's birth certificate that also asks if the baby was transported to the hospital within  24 hours of birth, which implies there was a complication or concern that brought a baby from a planned home or birth center birth into the hospital.

post #232 of 394
It is good that Ohio has a clear set up on this and hopefully the instructions to who ever fills them out are clear . . It has not been the case in my state, or when they did that old Pang study in Washington state- . And in my state there are ways for both death and birth certificates to be double reported, and all the blinded info that goes to the cdc will be somewhat duplicated- i say somewhat because when they fill out the paperwork in the hospital they often say NO prenatal care even when we give them copies of the charts and they may use them to help fill out the birth certificate...
post #233 of 394
Right now in my state the paperwork proposal is that within 30 days of booking a client we have to report to the state info on that client and the intended physician back up and hospital that will be used in case of emergencies... They plan to be tracking everything from 5 weeks on...
post #234 of 394
Quote:
Originally Posted by mwherbs View Post

Right now in my state the paperwork proposal is that within 30 days of booking a client we have to report to the state info on that client and the intended physician back up and hospital that will be used in case of emergencies... They plan to be tracking everything from 5 weeks on...

 



Are you saying that all this info goes on the birth certificate?

Or, is this what the state requires as part of licensing for midwives?

Who is it that is proposing this paperwork and what is the purpose?

post #235 of 394
We fill out an extensive database for each client- part of the licensing up keep, something they can cross check on to be sure that we are following all of the laws/ protocols written into law- 3 pages currently will be 4 soon- part of the new rules would be that within 30 days of booking must have the intended backup and intended transfer hospital
post #236 of 394
Sorry post studdering
post #237 of 394

This was on huff post live yesterday and is a very succinct  summary of the issues.

http://live.huffingtonpost.com/r/segment/home-birth-statistics%2C-fetal-deaths-%26-injuries/51479633fe344411590004ba

post #238 of 394

here is  link to the more recent UK birth place study-   

 

http://www.netscc.ac.uk/hsdr/files/project/SDO_FR4_08-1604-140_V03.pdf

post #239 of 394
Quote:
Originally Posted by mothercat View Post

This was on huff post live yesterday and is a very succinct  summary of the issues.

http://live.huffingtonpost.com/r/segment/home-birth-statistics%2C-fetal-deaths-%26-injuries/51479633fe344411590004ba

Oh...

 

I am not a fan of Dr. Amy's site. It's going to take me a while to get through this. Do you find Dr. Amy to be a reputable source, Mothercat? 

 

First few words out of Dr. A my's mouth:

 

"American HB MWs aren't real MWs' 
...
"HB are essentially lay people who couldn't or wouldn't get the credential to be a CNM"  

 

Dr. Amy knows perfectly well that CNMs practice in a home setting. 

post #240 of 394

When exactly was the last time "dr." Amy was actually liscensed and practicing medicine?

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