Thoughts on new study showing homebirth increases risk of nenonatal death? - Mothering Forums

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#1 of 98 Old 07-01-2010, 03:10 PM - Thread Starter
 
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FTR, I had a successful homebirth and support homebirth. However, I find these numbers troubling. An acquaintance mailed me these links this morning, btw. Would love to hear thoughts from the professionals.

http://news.bbc.co.uk/2/hi/health/10465473.stm

http://www.newscientist.com/blogs/sh...risk-of-b.html

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#2 of 98 Old 07-01-2010, 03:15 PM - Thread Starter
 
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Found this:

http://www.theglobeandmail.com/life/...rticle1624918/

Not enough info there for me, though.

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#3 of 98 Old 07-01-2010, 06:21 PM
 
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Yup. Scaremongering. Just like the circumcision study and its stats. It may be "double" but the risk is still extremely SMALL. .09 for hospital but .2 for home? I guess if everyone in America was having homebirths then there might be some changes, but homebirths are what, still less than 1-3% of births? That number is not high enough to stop women from their right to birth at home!

The hospitals will use this to keep their services the status quo, unfortunately. Costs too much $$$ to make a hopsital even more "homelike"....

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#4 of 98 Old 07-01-2010, 09:43 PM
 
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Yup. Scaremongering. Just like the circumcision study and its stats. It may be "double" but the risk is still extremely SMALL. .09 for hospital but .2 for home? I guess if everyone in America was having homebirths then there might be some changes, but homebirths are what, still less than 1-3% of births? That number is not high enough to stop women from their right to birth at home!

The hospitals will use this to keep their services the status quo, unfortunately. Costs too much $$$ to make a hopsital even more "homelike"....
but that is still double the rate= twice as many dead babies. coming from a mom who lost a perfect baby due to a midwife failure, this is important to note.

why CPMs are less safe than CNMs, is due to training differences and lack of doctor back up (for CPMs). it is something that needs addressing. woman should not have to chose between experience or safety-they should have both.

mdcblog5.gif   Liz mama to DS 10, DSS 9, DD 6, DS 3, DD 2 , Aquila- dec 19th 2009 died at my homebirth, and....welcome Willow born 9-16-10 (9 weeks early)  nut.gif
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#5 of 98 Old 07-01-2010, 10:46 PM
 
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So so sorry for your loss liz-hippymom.. but the truth is that babies and mommas do die in hospitals. A hospital birth does not guarantee a healthy baby. The study is flawed for many reasons - follow it through to the source and draw your own conclusions. It does not prove worse outcome in homebirth in my understanding.
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#6 of 98 Old 07-01-2010, 11:12 PM
 
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If you happen to be the mother of one of the babies that makes up the extra 0.11 percent, this is bad news.

However, it also fails to go far enough. I lost my baby during a homebirth attempt. It wasn't my attendant's fault, and it actually wasn't even because I was having a homebirth...or even because I was having a HBAmC. It was because I was too freaking afraid to transfer to the hospital when I should have, because I expected to be treated like a...thing...a fool and an incubator, just as I had been in all my previous stays. The doctors who traumatize women so badly get no blame in studies like this. It all comes down to "she was going to have the baby at home".

Things weren't going quite right. I should have transferred. I didn't. IMO, the death of my son was my fault...but there were definitely accessories (including both my previous "care" providers and whoever called social services on me).

IMO, almost any research on birthing places is going to paint way too simplistic a picture to be terribly useful.

ETA: I also noted that the article said the increase was largely due to lack of ability to resuscitate newborns who were in respiratory distress/failure. What if "lay" midwives had oxygen? How much difference would that make?

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#7 of 98 Old 07-02-2010, 12:37 PM
 
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ETA: I also noted that the article said the increase was largely due to lack of ability to resuscitate newborns who were in respiratory distress/failure. What if "lay" midwives had oxygen? How much difference would that make?
The evidence is that oxygen isn't any better than just plain room air. I think it would be wrong of MWs not to carry bag and mask resuscitation gear, but forgoing the oxygen for neonatal resuscitation is not such a huge deal (I've seen it help moms though, and for preventing a transfer for a baby that just needed a little more transition time but was already breathing). What most homebirth midwives can't do is intubate...that is SO rarely necessary in the homebirth population, but when we're talking about 1:500 death rates, this might be part of it. When families ask about what kind of resuscitation gear and training midwives have, I do let them know that I have the first several steps, and that the hospital has two main tools that I don't (intubation and epinephrine injection).

The above commentary is entirely aside from what the article is saying about the rates of complications and death; I haven't really dug into it yet.

Mama, homeschooler, midwife. DD (13yo), DS (11yo), DD (8yo), DD (3yo), somebody new coming in November 2013.

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#8 of 98 Old 07-02-2010, 01:34 PM
 
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I do let them know that I have the first several steps, and that the hospital has two main tools that I don't (intubation and epinephrine injection).

.
and those are the two things that would have potentially made a big difference in my birth. in some countries midwives are trained in intubation.

mdcblog5.gif   Liz mama to DS 10, DSS 9, DD 6, DS 3, DD 2 , Aquila- dec 19th 2009 died at my homebirth, and....welcome Willow born 9-16-10 (9 weeks early)  nut.gif
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#9 of 98 Old 07-02-2010, 02:05 PM
 
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and those are the two things that would have potentially made a big difference in my birth. in some countries midwives are trained in intubation.
The justification for us not being allowed to intubate is that we'd do it so rarely that we wouldn't have the skill level necessary to do it right. That makes next to no sense to me, because emergency responders are supposedly trained to do it but if you ask any random EMT or medic if they've done a neonatal intubation, they are going to say they haven't; they don't get practice at it either. I would much rather have the ability to intubate and never need to do it than the other way around; that, though, is considered outside my scope of practice.

Mama, homeschooler, midwife. DD (13yo), DS (11yo), DD (8yo), DD (3yo), somebody new coming in November 2013.

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#10 of 98 Old 07-02-2010, 03:21 PM
 
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why CPMs are less safe than CNMs, is due to training differences and lack of doctor back up (for CPMs). it is something that needs addressing. woman should not have to chose between experience or safety-they should have both.
Here in FL, the CPMs I know do have OB back-up... and are in close-connection with those OBs. It may not be the same in the rest of the country, but just wanted to add that. I'm also 99% sure that all CPMs have to hold their AAP NRP card as part of licensure. Most midwives also do carry oxygen.

My guess is that because this study encompasses homebirths in a wide variety of countries/situations--training, as well as distance to hospital--may play a part in these deaths. Of the midwives I know who do homebirths, they are very aware of transfer time/needs, etc. However, if one was doing a homebirth in a rural situation, even in the best of cases the hospital or emergency personnel may simply be too far away to offer any help.

Mom to DS(8), DS(6), DD(4), and DS(1).  "Kids do as well as they can."

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#11 of 98 Old 07-02-2010, 08:01 PM
 
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Here in FL, the CPMs I know do have OB back-up... and are in close-connection with those OBs. It may not be the same in the rest of the country, but just wanted to add that. I'm also 99% sure that all CPMs have to hold their AAP NRP card as part of licensure. Most midwives also do carry oxygen.

My guess is that because this study encompasses homebirths in a wide variety of countries/situations--training, as well as distance to hospital--may play a part in these deaths. Of the midwives I know who do homebirths, they are very aware of transfer time/needs, etc. However, if one was doing a homebirth in a rural situation, even in the best of cases the hospital or emergency personnel may simply be too far away to offer any help.
not here in Texas. in Austin not even CNMs have OB backup, and especially not CPMs. maybe your state laws help it to be the only state where homebirth is required to be covered by insurance?

mdcblog5.gif   Liz mama to DS 10, DSS 9, DD 6, DS 3, DD 2 , Aquila- dec 19th 2009 died at my homebirth, and....welcome Willow born 9-16-10 (9 weeks early)  nut.gif
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#12 of 98 Old 07-02-2010, 09:41 PM
 
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Most troubling to me is the lack of standardized ongoing risk screening in CPM/LDM/DEM managed births in the US. The safety evidence found in the studies on home birth out of the Netherlands and Canada relies on clear, thorough risk screening throughout pregnancy and birth. No breech, no twins, no pushing for 12 hours. Plus clear guidelines for ongoing surveillance of both mom and babe. Ensuring a low risk Mama and babe results in good outcomes. Inclusion of high risk will result in higher incidence of adverse outcomes, including fetal death. High risk conditions can develop at any point in pregnancy or birth, must be quickly identified, and patient transferred for hospital management.

Mandatory data collection of all out of hospital births needs to be initiated in the US to finally capture true outcomes. I do believe this meta analysis has flaws---but I am not convinced true outcomes of CPM/LDM/DEM births in the US are not even more concerning than reported in the results. I think that is a travesty as I do believe home birth with careful screening can be as safe as hospital birth. Transparency, in my mind, will lead to evolution of practice in the US.
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#13 of 98 Old 07-02-2010, 09:53 PM
 
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I am not understanding what a back-up physician's role would be as far as helping prevent situations. I have worked with different docs over the years and it doesn't really do much for the client when there is an emergency you still need to be seen by the first available and that would not make a whit of difference who you have seen prenatally other than to offer you someone else to sue or someone for them to chastise-- in fact one of my earliest back up docs was so much more radical than we were he made me very nervous - he absolutely did not believe in post-dates at all and on the other hand he would coach us and the women you have to play your "role" I will meet you at the hospital but I will play it by the book it is up to you to raise a fuss and refuse the things you want to refuse- so basically no reliable guidance once you get into the hospital. I have also worked with a cnm who does home birth and doula'd for clients in a birth center run by cnms- the only thing different that a homebirth cnm could do at home was to offer Rx drugs for gbs, sleeping pill for prodromal labor and an anti-nausea drug with IV and to do prosta gel for inductions,(as well as rx management and treatment prenatally )- the birth center gals will do the gbs, and and IV for vomiting but not the gel, none of the CNMs I know will risk intubation and they don't have the other drugs on hand either- I also take the neonatal resuscitation classes with the nurses and CNMs as well as other midwives and students - we do the same class and practice-the in hospital nurses defer to the neonatal nursery nurses as far as resuscitating a baby---
I read the English commentary which recommended that 2 midwives attend births in case resuscitation is needed and I agree- when a baby has needed resuscitation - it is easier as a team and at the very least someone to help manage mom's needs while the other is doing resuscitative efforts.
-----------------
on the topic of high risk we know by definition that high risk births are intentionally being included in the homebirth outcomes - and they should be matched with women of equal "risk" status in the hospital birth community.
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#14 of 98 Old 07-02-2010, 10:34 PM
 
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So sorry hippymom. I was thinking the same thing when I mentioned the numbers. It is still double the babies. I guess I was just trying to make a point that more people having homebirths could be more babies.... It was a horrible statement. Sorry

I like the intubation argument though. I totally think they should teach it. One of our midwives had a baby with a bone spur in its windpipe. She kept the baby attached to momma, started oxygen and called 911 and asked if they had neonatal resuc. equipment and to bring it. They showed up and didn't have it!!!!!! Still attached to mom....got to hospital, detached, baby crashed, was brought back to life. And the MIDWIFE would have been to blame....NOT the paramedics or the ambulance company, who BY LAW are supposed to have neonatal intubation, etc. equipment on board.

It could have been a loss totally averted by her having the skills and the numbnut paramedics having the equipment. Argh.

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#15 of 98 Old 07-02-2010, 11:18 PM
 
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We transported once and the ambulance team detached our oxygen tank and took baby to the hospital and their tank was empty.

No DEM/CPMs I know in my state don't know how to resuscitate. We all take Karen Strange's class every two years. I arranged the last one this past May myself. If resuscitation is the issue then they are including people I would call lay midwives and not trained DEM/CPMs in this study.
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#16 of 98 Old 07-02-2010, 11:29 PM
 
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on the topic of high risk we know by definition that high risk births are intentionally being included in the homebirth outcomes - and they should be matched with women of equal "risk" status in the hospital birth community.

The issue/problem isn't that "high risk births are intentionally being included in the homebirth outcomes" The issue is that high risk births are being managed out of hospital in the first place. We know high risk inclusion will increase incidence of mortality and significant morbidity. Successful international home birth models that have demonstrated positive outcomes screen out all high risk with ONGOING risk screening. US CPM/DEM/LDMs must follow suit or will have unacceptable mortality and morbidity rates.
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#17 of 98 Old 07-03-2010, 12:19 AM
 
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NM...didn't realize this was the birth professionals forum - saw the thread from the main index page.

(And, I didn't realize that oxygen wasn't useful - just meant that there's no reason why a midwife, of whatever sort, can't be trained in resuscitation techniques...unless it's because of more turf war crap with pregnant women as the turf.)

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#18 of 98 Old 07-03-2010, 12:30 AM
 
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We're talking about it over here: http://www.mothering.com/discussions....php?t=1239494

I read the study in its entirety and I felt like it had a lot of holes in it. Primarily, when you combine all the mortality rates, as far as I can ascertain, it actually shows a higher total mortality rate in the hospital births. That treble risk came from a break-out group of just five percent of the births.

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#19 of 98 Old 07-03-2010, 12:38 AM
 
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The issue/problem isn't that "high risk births are intentionally being included in the homebirth outcomes" The issue is that high risk births are being managed out of hospital in the first place. We know high risk inclusion will increase incidence of mortality and significant morbidity. Successful international home birth models that have demonstrated positive outcomes screen out all high risk with ONGOING risk screening. US CPM/DEM/LDMs must follow suit or will have unacceptable mortality and morbidity rates.
One other thing that the Dutch and Canadian systems have in common is that the midwives can and do work in both home and hospital settings. I think there are almost 300 midwives in my state, but I only know of one or two homebirth midwives who have hospital privileges. Also the management of higher-risk births has gotten totally out of hand here. When you can't have twins in a hospital vaginally or VBAC or vaginal breech anywhere in a particular area (even though medical evidence firmly supports the safety of those choices), you have to expect that some women are going to be driven to either UC or providers who are outside the system. Also as long as we value personal and religious freedom in the U.S., there are always going to be entire religious communities who give birth out of the hospital to nearly all of their babies, whether high risk or not. The Dutch and Canadian midwives have very high hospital transport or transfer rates, but a lot of the time they are just changing location -- the midwife is still the care provider or giving concurrent care with an OB. It is a totally different situation to be a CPM in most places in the U.S. where transferring care sometimes feels like throwing the mom to the wolves.

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#20 of 98 Old 07-03-2010, 02:00 AM
 
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The issue/problem isn't that "high risk births are intentionally being included in the homebirth outcomes" The issue is that high risk births are being managed out of hospital in the first place. We know high risk inclusion will increase incidence of mortality and significant morbidity. Successful international home birth models that have demonstrated positive outcomes screen out all high risk with ONGOING risk screening. US CPM/DEM/LDMs must follow suit or will have unacceptable mortality and morbidity rates.
that is an opinion- rather than ban "high risk" outright since women are making the choice to give birth in that way then a real look should be had- as far as we know even some high risk may have better stats at home- until it is honestly looked at and compared we don't know- and the thing is that there could be honest stats had in most licensing states- I know that it isn't the mw's decision to be excluded from accurate record keeping- our state requires all midwives to hand in a very detailed quarterly report- might as well photo copy the records- that is how detailed they are- but no money to number crunch anything and there is no "law" allowing /requiring that data to be used for stats - I know in Washington state that the health department (not the nurse investigators) have supported midwife attended births because their stats show better outcomes (again in house info rather than public required data) - so one hand doesn't know what the other is doing---
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#21 of 98 Old 07-03-2010, 03:07 AM
 
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I've always been curious as to what the numbers would look like in an OB/CNM attended home birth. This is exactly what I'm planning and between the two of them they can do pretty much everything but a c/s. Being that I'm HBACing, I am very happy with this birth team and that my doc has privileges at two major hospitals within 15 minutes. I feel very fortunate but I'd still love to see numbers even though I'm sure it's impossible since docs don't generally attend hb's anymore in the US.

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#22 of 98 Old 07-03-2010, 09:35 AM
 
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That study, as far as I'm concerned, is irrelevant due to it's flaws.

In researching any topic, I pretty much rule out the use of anything more than about 5-10 yrs old (including any more recent study that contains some material, as this one does, that is so old). So much changes in our understanding over time; our understanding of pregnancy and birth, how they work, what makes things 'go right' or 'go wrong', is modified/expanded over time. Besides, there is really no way to determine all the factors that may lead to poor outcomes when the subjects included are so far back in years.

Anyone who wants to argue that hb isn't safe enough needs to work with better material than this! At least, they do if they want to be taken seriously. I'm kind of surprised that anyone here actually does consider this to be a serious study worth so much discussion--I find it idiotic:

Generally speaking, there is NO information out there that is truly unbiased and objective. Those are ideals we aim for, sure--and some researchers get closer to 'objectivity' than others. But humans being merely human, it is impossible to study something without bias, we always carry our preconceptions/beliefs into our work and our days of life. Those beliefs impact everything, every event and 'outcome'. I think it is extremely important to bear this in mind when reading any research--to have a critical eye, to know from the get-go that there is bias in everything, and even to remember that we readers of studies ALSO have our biases (which means, don't rule out a study because it doesn't happen to agree with you, just as much as you should not approve a study because it DOES agree with you).

The people who conducted this study clearly had a bias against homebirth! And the proof of that is that they had to include such old and useless info in their study. They were really really reaching for some sort of 'evidence', and were able to couch it in 'smart sounding research terms'--but don't miss the fact that in order to show hb is less safe than hospital birth, they did have to reach to an absurd degree.

I mean hey, we could also say that hospital birth is inherently unsafe because such a high % of women die of childbed fever there! WEll, they DID--back several decades ago! See what I mean??? But we obviously don't draw upon such old info now...and clearly (more importantly), over time it was learned that docs with dirty hands were causing so much pp death...we learned about germs and germ-transmission and many other things that have changed that particular outcome/stat. Just as we have learned so much about homebirth that has impacted present outcomes/stats.

Homebirth is as safe as families and providers together make it. It is true that some homebirth providers do not have sufficient knowledge/skills regarding complications as others..and that can lead to poor outcomes that may have been avoided. Just as it is true that some (most?) hospital-based HCPs do not have sufficient knowledge/skills concerning NORMAL BIRTH--and this leads to poor outcomes of varying degrees EVERY DAY in hospitals (poor outcomes of varying degrees, including needless csec as a 'poor outcome' along with a host of other issues that sure, the med ppl can 'fix', but it is their lack of knowledge of normal that causes problems for so many women--up to and including death or permanent harm).

The answer, as I will tell you again bailefeliz, is NOT to make more women birth in the hospital--where women/babies are fairly guaranteed some degree of harm or needless meds/procedures being conducted during/after their births.

The answer is for hb mws to get training, by any means, and to know their limits. With this means participating in peer review, in ongoing education, and in all possible ways being accountable for their training and actions. This is especially true for unregulated mws, who have no license board to oversee their training, outcomes, etc. But it's also true for regulated mws...you can't rest on your laurels, and you can't hide behind 'following protocols' but must be able to have clear sight and review to keep you sharp.

And the 2nd part of the answer is for families to take nothing for granted, but to carefully vet mws before choosing one. Families need to be highly pro-active in choosing care providers, as well as highly pro-active in maintaining their own health and preparing as well for 'what can go wrong' during birth. I don't care how many of your friends simply LOVED a mw and had a great birth with her, or how well you feel you 'click' with her. Since most women when unhindered DO have normal births (through NO action of the mw, but only because birth works), the experience of your friends means nothing if they have not seen that mw work with complications.

Anyway, that study is just absurd to me!
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#23 of 98 Old 07-03-2010, 10:10 AM
 
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Originally Posted by bailefeliz View Post
Most troubling to me is the lack of standardized ongoing risk screening in CPM/LDM/DEM managed births in the US. The safety evidence found in the studies on home birth out of the Netherlands and Canada relies on clear, thorough risk screening throughout pregnancy and birth. No breech, no twins, no pushing for 12 hours. Plus clear guidelines for ongoing surveillance of both mom and babe. Ensuring a low risk Mama and babe results in good outcomes. Inclusion of high risk will result in higher incidence of adverse outcomes, including fetal death. High risk conditions can develop at any point in pregnancy or birth, must be quickly identified, and patient transferred for hospital management.

Mandatory data collection of all out of hospital births needs to be initiated in the US to finally capture true outcomes. I do believe this meta analysis has flaws---but I am not convinced true outcomes of CPM/LDM/DEM births in the US are not even more concerning than reported in the results. I think that is a travesty as I do believe home birth with careful screening can be as safe as hospital birth. Transparency, in my mind, will lead to evolution of practice in the US.

mdcblog5.gif   Liz mama to DS 10, DSS 9, DD 6, DS 3, DD 2 , Aquila- dec 19th 2009 died at my homebirth, and....welcome Willow born 9-16-10 (9 weeks early)  nut.gif
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#24 of 98 Old 07-03-2010, 10:14 AM
 
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Originally Posted by MsBlack View Post
I'm kind of surprised that anyone here actually does consider this to be a serious study worth so much discussion--I find it idiotic:
i am pretty sure MDC has rules pertaining to snarky comments such as this. Just because you don't like/agree with the study, does not mean the people discussing it are idiotic.

mdcblog5.gif   Liz mama to DS 10, DSS 9, DD 6, DS 3, DD 2 , Aquila- dec 19th 2009 died at my homebirth, and....welcome Willow born 9-16-10 (9 weeks early)  nut.gif
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#25 of 98 Old 07-03-2010, 10:35 AM
 
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Originally Posted by MsBlack View Post

The answer, as I will tell you again bailefeliz, is NOT to make more women birth in the hospital--where women/babies are fairly guaranteed some degree of harm or needless meds/procedures being conducted during/after their births.
Two thought on this:

1. I completely agree. In addition, I would say that the answer is a greater collaboration between physicians and CPMs. Unfortunately, I don't know how to enforce that legally. But I can't tell you often midwives are demonized for transferring their clients when, in fact, they should have been congratulated for acting responsibly and exercising sound judgment. I wonder if this study factored in states where midwifery is illegal....

2. The timing of this study couldn't be better for ACOG. Remember, they want to drive home birth underground. This article provides the ammunition for legitimizing their cause.

Finally, remember that we're all speculating. Nobody has read or even seen the actual study, am I right? From what I vaguely understand, it includes some profoundly weak and well-discredited studies while neglecting any mention of the 2005 North American home birth study. If this is true, we have ourselves a cherry-picked "meta"-analysis.

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#26 of 98 Old 07-03-2010, 10:41 AM
 
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Originally Posted by bailefeliz View Post
Mandatory data collection of all out of hospital births needs to be initiated in the US to finally capture true outcomes. I do believe this meta analysis has flaws---but I am not convinced true outcomes of CPM/LDM/DEM births in the US are not even more concerning than reported in the results. I think that is a travesty as I do believe home birth with careful screening can be as safe as hospital birth. Transparency, in my mind, will lead to evolution of practice in the US.
Fair enough. I completely agree. But what about transparency with hospitals?

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#27 of 98 Old 07-03-2010, 10:45 AM
 
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Originally Posted by Amynf1 View Post
I've always been curious as to what the numbers would look like in an OB/CNM attended home birth. This is exactly what I'm planning and between the two of them they can do pretty much everything but a c/s. Being that I'm HBACing, I am very happy with this birth team and that my doc has privileges at two major hospitals within 15 minutes. I feel very fortunate but I'd still love to see numbers even though I'm sure it's impossible since docs don't generally attend hb's anymore in the US.
For references to CNM v. CPM-attended home births, check out the back of Henci Goer's book, The Thinking Woman's Guide to a Better Birth. CNMs oversee so few home births that there is little interest in researching them. There are some older studies, however.

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#28 of 98 Old 07-03-2010, 10:49 AM
 
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Originally Posted by Turquesa View Post

2. The timing of this study couldn't be better for ACOG. Remember, they want to drive home birth underground. This article provides the ammunition for legitimizing their cause.

.
i would like to see someone post from another (perhaps more substantiated) site about this supposed plot.

mdcblog5.gif   Liz mama to DS 10, DSS 9, DD 6, DS 3, DD 2 , Aquila- dec 19th 2009 died at my homebirth, and....welcome Willow born 9-16-10 (9 weeks early)  nut.gif
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#29 of 98 Old 07-03-2010, 11:23 AM
 
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Originally Posted by liz-hippymom View Post
i am pretty sure MDC has rules pertaining to snarky comments such as this. Just because you don't like/agree with the study, does not mean the people discussing it are idiotic.
I didn't read this at all as her calling the people idiotic, but as calling the study idiotic.

Erika, mama to three beautiful kids (plus one gestating), and wife to one fantastic man.

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#30 of 98 Old 07-03-2010, 11:39 AM
 
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Originally Posted by MsBlack View Post
The answer, as I will tell you again bailefeliz, is NOT to make more women birth in the hospital--where women/babies are fairly guaranteed some degree of harm or needless meds/procedures being conducted during/after their births.

The answer is for hb mws to get training, by any means, and to know their limits. With this means participating in peer review, in ongoing education, and in all possible ways being accountable for their training and actions. This is especially true for unregulated mws, who have no license board to oversee their training, outcomes, etc. But it's also true for regulated mws...you can't rest on your laurels, and you can't hide behind 'following protocols' but must be able to have clear sight and review to keep you sharp.
I'm intruding a bit in this forum I know but I have to say one of the things I value about midwives in my province is that they do work in hospitals as well as at home. I am doing some thinking about providers right now as I'm 7 weeks pregnant, and my first child died due to a birth accident. For my second I opted for a star obstetrician - a true star; one who helped me get comfortable enough to go for a vaginal delivery with very few interventions, by making all the interventions available and walking through all the decision making tree with me.

The only way I would feel comfortable with a midwife would be in a hospital setting. I don't think it has to be homebirth/midwife vs. hospital/every-intervention-known-to-man.

I could not in good conscience choose a midwife who wasn't willing to examine both the overriding studies and the individual ones and make observations about how risk was managed in order to understand why the rates were/may have been higher in some settings. I understand that the climate in some countries makes everything political but I think it is important that all medical professionals strive for evidence-based care.

~ Mum to Emily, March 12-16 2004, Noah, born Aug 2005, Liam, born January 2011, and wife to Carl since 1994. ~
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