Originally Posted by andreap http://www.medscape.com/viewarticle/811222
honestly, it doesn't really make sense to me and I was just wanting some input as to WHY this would ever be the case??? I truly do not understand. any thoughts??
I think the two main possible reasons why this would be happening would be:
1. Lack of proper monitoring in the homebirth setting, meaning fetal distress in labour doesn't get picked up until the baby's born in a bad way
2. The factor Katie8681 mentioned in post #12 above - better resuscitation facilities in the hospital. If a baby pops out with a low Apgar, they can be resuscitated more effectively with hospital facilities.
The other question here, of course, is "Why does this study give contradictory results to the study Lactofairy cited, above?" I think the answer to that is that the two studies took place in different countries with different medical systems. From the reading I've done on homebirth, it seems (logically enough) that the safety of homebirth depends heavily not just on the individual woman's risk level, but also on some key factors in the medical system within which this is taking place:
- Good midwifery training, including good training on how to recognise and deal appropriately with emergencies
- An excellent ambulance system for emergency transfer.
- An integrated midwifery/obstetrics system to make transfers as smooth as possible when they do have to occur.
I don't know about Canada (though the article does actually answer the first point, at least - it sounds as though they do have extremely good midwifery training) but my understanding, from what I've read, is that the US medical system falls down badly on all three points. (That may be a generalisation - hopefully it isn't true for the whole of the US, but even if it's true in many places then that's going to affect the overall figures.) In particular, the US seems to have a two-tier midwifery system whereby a category of midwives (I think these are the DEM midwives? I can check whether I have that right) have had substantially less training than the others, yet are still out there practicing. So, if they're not as good at monitoring women properly or recognising emergencies when they arise, then that's going to lead to a lot of increased cases of babies born with previously unrecognised distress. And then, if they're not as well trained in resuscitation, they may be less good at keeping the baby going until the ambulance gets there, hence a worse Apgar score at 5 mins. Meanwhile, there may also be more problems with *getting* an ambulance in the US compared to some other countries, so there are delays in transferring the baby to hospital... etc.
Anyway, that would explain the different results in the two studies: homebirths are low risk in Canada, but appear to carry increased risk in the US, probably due to issues in the medical system.