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#1 of 32 Old 09-19-2013, 07:19 AM - Thread Starter
 
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*****TRIGGER*****






so i am pregnant with my first and am planning a homebirth with midwives i really love. i have felt absolutely great with this decision, having researched it for a while now, but came across this yesterday and it has sparked some of wild fears in my mind regarding homebirth!

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??
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#2 of 32 Old 09-19-2013, 08:14 AM
 
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Planned homebirth with a trained competent caregiver is as safe as or safer than a hospital birth.  There have been many studies that have proved this.  The last link below in one study showing this.

 

 

http://www.babycenter.ca/a536331/home-birth-and-midwifery

 

http://www.cbc.ca/news/technology/home-birth-with-midwife-safe-as-hospital-1.862485

 

http://www.cmaj.ca/content/181/6-7/377.full

 

Often poorly done studies on homebirths include the births of babies born accidentally at home, often very premature.  That is a very different situation from a planned homebirth with a competent midwife for a health pregnancy.

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#3 of 32 Old 09-19-2013, 08:18 AM
 
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#4 of 32 Old 09-19-2013, 08:18 AM
 
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I think there is a thread on here discussing that article already, will see if I can find it.

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#5 of 32 Old 09-19-2013, 08:28 AM
 
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I can't tell if this is the same article but here are some discussions on similar topics.

 

http://www.mothering.com/community/t/1385809/apgar-score-of-zero-at-five-minutes

 

http://www.mothering.com/community/t/1375250/thoughts-on-planned-home-births-are-associated-with-double-to-triple-the-risk-of-infant-death-than-are-planned-hospital-births

 

most modern obstetric interventions were developed to mitigte the risk of intrapartum hypoxia and subsequent brain damage or death.

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#6 of 32 Old 09-19-2013, 08:32 AM - Thread Starter
 
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thanks! I would love to find the other thread. I'm a big proponent of homebirth and it just didn't make sense to me as to why this particularly risk would be soooo much higher.

This study did just come out and it is a pretty large scale study assessing this risk in planned home births.... although I'm not really sure how you can tell if it was a planned homebirth based on the birth certificates. I'm not sure if they included unassisted childbirths or not.

anyways, my pregnancy hormones are running wild with this one and I guess I just needed a little reassurance =)
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#7 of 32 Old 09-19-2013, 08:35 AM - Thread Starter
 
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thank u for the links!
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#8 of 32 Old 09-19-2013, 09:57 AM
 
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I think it's primarily because home birth in the US is not always low-risk women with a highly competent care provider. I know I'm not the only one saying so. This study probably reflects the reality of home birth, today, in the US.
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#9 of 32 Old 09-19-2013, 05:08 PM
 
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Quote:
Originally Posted by Katie8681 View Post

I think it's primarily because home birth in the US is not always low-risk women with a highly competent care provider. I know I'm not the only one saying so. This study probably reflects the reality of home birth, today, in the US.

 

The article does say "the critical factor is the location of the birth, not the training of the professional involved in delivery," 


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#10 of 32 Old 09-19-2013, 06:25 PM
 
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Quote:
Originally Posted by phathui5 View Post
 

 

The article does say "the critical factor is the location of the birth, not the training of the professional involved in delivery," 

 

I wonder if that's because hospitals are more likely to use cefm/efm and intervene at late decels, whereas even if late decels are detected in a home delivery, there is very little a midwife can do besides have the mother chance positions or transfer.

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#11 of 32 Old 09-20-2013, 07:30 AM
 
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I just felt the need to reply to the comment about "CEFM" and "EFM" for those that don't understand medical jargon.  This means continuous electronic fetal monitoring.  If you do a web search on continuous fetal monitoring, you will see that in the past 2 decades the research is VERY clear.  The ONLY correlation between CEFM and healthy babies (I think the research-speak refers to it as "neonatal outcomes") is that there is NO benefit to reducing neonatal morbidity or mortality by using CEFM.  The ONLY thing CEFM consistently does and has done over 2 decades is drastically increase the C-section rate for "fetal distress" that is false. Many people falsely believe that CEFM can determine true danger to the baby, when in only VERY rare instances does it in fact do this.  In the past several years many well-respected organizations (the Cochrane Review, ACOG, among others) have recommended that hospitals STOP all CEFM.

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#12 of 32 Old 09-20-2013, 08:34 AM
 
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Originally Posted by phathui5 View Post

The article does say "the critical factor is the location of the birth, not the training of the professional involved in delivery," 

I am not really surprised. In a hospital if you have a flat baby, you have an L&D nurse, a NICU nurse available, a respiratory team for help with intubation... It makes sense that
without those things, a 5 min apgar of 0 is more likely.
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#13 of 32 Old 09-20-2013, 10:21 AM - Thread Starter
 
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philomom,

I have read about and personally experienced plenty of healthy, happy homebirth babies, so although your stories are valid, i don't think they encompass the general safety of homebirth in any way, shape, or form.

I wrote my question with the understanding I would be answered by others who were either supportive of, or wanted to learn about, homebirth. I did not really expect someone who is unsupportive of homebirth trying to scare me out of it. I just wondered why this particular phenomenon in the study would be the case. and I do not think most homebirth supporters are just so blinded by their own selfish desires to have the "perfect birthing experience". I know that I, personally, believe that if I continue to remain low-risk, my home, with my midwives, is the safest place to ensure the health of my baby =)

thanks for reading
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#14 of 32 Old 09-20-2013, 10:39 AM
 
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I said cefm/efm because late decels can be detected with correctly done intermittent monitoring.  A competent midwife could certainly detect them and initiate a transfer.  But she would not have the full range of tools (operating rooms, surgeons, nursing teams) to deal with potential hypoxia, only the ones she can bring with her as a midwife, so if late decels appear too late in a labor to transfer, a baby who is suffering from hypoxia may continue to do so.  I believe the research is quite clear that babies with normal heart tracings are generally not at risk for hypoxia, but that babies with late decels are at risk for hypoxia and sometimes death.  Some of the babies will be fine without intervention and some of the babies will be injured or die without intervention but there is often no way to predict which babies it will be just from the heart tracing.  So the standard of care is to monitor and intervene for late decels.  This is not the same as "unnecessary."  Unnecessary would be if interventions were being applied to babies with normal heart tracings.   This is preventative medicine.

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#15 of 32 Old 09-20-2013, 12:21 PM
 
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So the correct response would be: The study is wrong; no reason not to have a home birth. Or: I don't know if the study is well done or not, but still have a homebirth.

If the study reflects reality, the fact may be that even if you are low risk and you have excellent midwives, you face an increased relative increase of having a baby starved of oxygen at birth, albeit still a very small absolute risk, still.

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#16 of 32 Old 09-20-2013, 12:35 PM - Thread Starter
 
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umm....I'm not sure that's what I said so I'm slightly confused by your comment but I do apologize if that's how it came across.

If you think the study is valid (which obviously I believe there is a degree of validity to it) then my question was, why would this be the case, not "please try to talk me into or out of home birth"

Again, I suppose I incorrectly assumed that the homebirth board was for those that support/are learning about homebirth. if that is not what this is, that's alright. =) I really was not asking whether or not I should have a homebirth...my question was not even personal to me or my situation at all. it was a question as to why this study would have these results. again, I plan on making (with my dh) the best decision for my baby and myself.

thanks for the input =)
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#17 of 32 Old 09-20-2013, 12:50 PM
 
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We are all learning about home birth. I think these results are something to consider.
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#18 of 32 Old 09-20-2013, 12:57 PM - Thread Starter
 
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I completely agree =) and I definitely do and will
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#19 of 32 Old 09-21-2013, 12:41 AM
 
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Quote:
Originally Posted by andreap View Post

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.

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It is kind of interesting & fun to try to figure out where these kind of figures come from, but I believe in due time the reality will come out in the press.  A similar sensationalistic headline appeared approximately 3 years ago when the headline read "3 times more babies die from home birth".  This "study" was criticized by many professional agencies worldwide and was eventually disproven because of known flaws by the doctors that published this study by ACOG.  But, by the time the study was disproven, the damage was done.  The American people don't generally read articles, they read and believe headlines.  Many still believe home birth kills 3 times more babies.  Canadian doctors suggested ACOG's publication of this "study" was politically motivated (to turn people against home birth).  In other words, they knew the study was flawed, they couldn't find good research to show home birth was dangerous, so they published the study in hopes to sway those people that would be gullible enough to believe it.  I believe the same situation will be found with this new "study".

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#21 of 32 Old 09-21-2013, 09:17 AM
 
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I don't totally disagree, but I find talking about mothers who are only interested in their birth experience VERY simplistic & trivializing. Honestly, if I were only interested in MY experience, I would choose a hospital with an Epi every time. Epidurals are 95% about the mother's 'experience'. It is actually about increased *morbidity* for mothers in US hospital births. This can include Cesareans when they are not necessary, episiotomies, etc. Many US hospitals have outrageous rates of interventions, for which they are NOT getting better outcomes than hospitals with much lower rates.

In fact, I am most likely birthing @ a hospital this time but only because they have a 20% section rate (appx) vs. the 40+% that is common & average where I used to live (and where I did choose a HB).

But none of it is about my experience, in fact it is about my safety, my health future & the integrity of a major organ which I know I will be better off keeping (hysterotomy can often lead to later Hysterctomy) & keeping intact. We would never question men for being interested in their bodily integity & avoiding surgery if @ all possible, if they were the ones giving birth.

I believe we can have both healthy mothers & healthy babies with evidence based care, but sloppy OBs all over the US will throw a mother's body under the bus for that healthy baby. And in many situations it makes sense for a mother to want to shield herself from that type of care, when it is all her local hospital is willing/able to offer.
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#22 of 32 Old 09-22-2013, 01:37 AM
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Just a reminder to everyone posting to this thread and in the Homebirth forum:

 

Quote:
 

The Homebirth (HB) forum is for support and sharing of information, ideas and experiences about the topic of homebirth. While we will not restrict discussions only to those who birth at home or in a freestanding birth center, members posting to this forum should have a sincere interest in learning about or supporting the option to HB.

 

philomom, I have removed your post as it was not in discussion of the OPs specific question and was not in accordance with the Homebirth guidelines. While it is expected that some discussion in this forum will be looking at risks of and concerns regarding homebirth, the intent of the forum is to provide a supportive discussion atmosphere for women to make their birthing decisions, even when explaining concerns and risks. 

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#23 of 32 Old 09-22-2013, 01:41 AM
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#24 of 32 Old 09-22-2013, 02:56 PM
 
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Just a reminder to everyone posting to this thread and in the Homebirth forum:


philomom, I have removed your post as it was not in discussion of the OPs specific question and was not in accordance with the Homebirth guidelines. While it is expected that some discussion in this forum will be looking at risks of and concerns regarding homebirth, the intent of the forum is to provide a supportive discussion atmosphere for women to make their birthing decisions, even when explaining concerns and risks. 

My post can still be seen because it was quoted by others. I did not mean to come off as anti-homebirth but I do think families should be aware of the increased risks.
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#25 of 32 Old 09-22-2013, 03:15 PM
 
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Saying 'mothers who birth @ home care only about their birth experience' isn't factual (because if mothers didn't care about their own experience, then many Anestiesiologists would be in the unemployment lines) & does sound pretty anti-HomeBirth. I don't disagree that there are risks, but 3 out of 5 is no where near accurate as far even the most pro-hospital numerical assessment of those risks goes.
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#26 of 32 Old 09-22-2013, 03:39 PM
 
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Idk if this tidbit is of info is of any help, but my baby was having late decels in my hospital birth and it was evidently due to dehydration, so more fluids is always a possible Solution too...

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#27 of 32 Old 09-22-2013, 04:32 PM
 
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Idk if this tidbit is of info is of any help, but my baby was having late decels in my hospital birth and it was evidently due to dehydration, so more fluids is always a possible Solution too...

 

Of course hydration is a solution if dehydration is the cause, but there are many many causes for late decels.  

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#28 of 32 Old 09-23-2013, 10:13 AM
 
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"members posting to this forum should have a sincere interest in learning about or supporting the option to HB."

 

I would like to support HB. But I would like to support HB under safe circumstances. If there are situations that pose risks during a HB, are these not things that we can discuss here?

 

It is not a universal truth that homebirth is "as safe as or safer than" hospital birth. There are many conditions that pose risks to mothers and babies. There are many situations where a mother and baby are more likely to fare better (much better) if they are in the hospital cared for by a physician. I am not saying this to fear-monger, but to be truthful. We need the truth to be informed about our decision making.

 

I love love love home birth, but I cannot support it under risky circumstances, nor in situations where there are not good professional working relationships with medical back up.

 

I think a lot of people come to this forum for information about OOH birth. I think philomom's post brought up some good points. Anecdotal, yes. But that information, IMO, needs to be part of the discussion.

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#29 of 32 Old 09-23-2013, 12:38 PM
 
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Right, it was just the stereotype about HB mamas essentially being BirthZillas that was the issue.

The 3/5 was just not an accurate representation of even the wildest assessments of the risks (which according to the paper are @ worst 4.36/1000 or 0.44%) but could very much be someone's IRL experience.
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#30 of 32 Old 09-23-2013, 01:44 PM
 
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I don't think the writer meant to say that 3/5ths of all home births will end poorly. She was honestly writing about her personal experiences with OOH birth.

If I had written (and I could say this in all honesty):

 

"Oh don't worry about anything. Seven of my friends and I had OOH births with midwives and everything turned out just fine."

 

Would this be taken to mean that OOH birth is safe 100% of the time?

Would my comment have been deleted?

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