Evidence based midwifery (spin off from new study threads) - Mothering Forums

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#1 of 29 Old 02-15-2014, 08:33 AM
 
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I am curious about what others are thinking about the recent home birth studies and current practices in home birth midwifery.  While all studies have their flaws, there is a lot of good information that can give us ideas about how to better home birth care in America.  I personally feel that we need more well trained midwives in all settings.  I think that women who are at increased risk would be much more likely to use resources available in hospital settings if they felt their autonomy would be respected.  In particular I would like to discuss:

Breech births at home: Out of the 127 vaginal breech births in the MANA stats study, 3 resulted in death of the newborn.  That is 2.36 out of 100!   I think that if women were told that their baby had a 1/50 chance of dying during a breech home birth they would be less likely to choice this option.  And what if they had the chance to VBAC with midwives in subsequent births.  Would that help their decision making process?

 

Only low risk births at home: The discussion in the MANA Stats section states "While the absolute risk[44] is still quite low, the relatively elevated intrapartum mortality rate in our sample may be partially a function of the higher risk profile of the MANA Stats sample relative to de Jonge et al,[10] Hutton et al,[12] and Stapleton et al[14] whose samples contain primarily low-risk, singleton, vertex births. When women who are at higher risk for adverse outcomes (ie, women with multiple gestations, breech presentation, TOLAC, GDM, or preeclampsia) are removed from our sample, the intrapartum death rate (0.85 per 1000; 95% CI, 0.39-1.31) is statistically congruent with rates reported by Hutton et al[12] and Stapleton et al,[14] although still higher than that reported by de Jonge et al." 

So perhaps these births should not be taking place at home.  GDM and pre-e?  Breeches and multiples gestations? I would like to hear others thoughts on these issues.

 

A midwife for every woman: What if women had the option of birthing anywhere they wished with well trained midwives.  What if hospitals were a place where women could go to birth and feel respected; where they were able to make informed decisions about the care they received? I think that if we have more midwives practicing in hospitals, we will see the climate change in these places.  I have seen this in hospitals around my area.  Those that have a higher percent of deliveries done by CNMs are far more mother/baby friendly.  Others that have no midwives practicing have >40% c-sec rates!

 

I still believe home birth can be a safe option for women.  I fooled around with the CDC wonder data base, and if I chose low risk demographics (vaginal birth, vertex position, singleton pregnancy, 37-41 weeks, normal birth weight)  home birth with a CNM gave neonatal mortality rate of .34/1000 hospital and .75/1000 home.  If I omitted primes, the rates are .33/1000 hospital and .39/1000 home. I chose CNM because I am going back to school to become a CNM and I wanted to know what risk my home birth clients would have.  I know that this is just working with raw data ( the home rate was suppressed and I divided it myself to get the .39) but I feel that together with recent studies it can give us an idea of what needs to be worked on.  And this is with the current system with sometimes difficult transfers.  Imagine if we were to streamline the system to be more home birth friendly? 

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#2 of 29 Old 02-15-2014, 10:13 AM
 
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I think this is a very reasonable and researched post! I'm Canadian, and in my province, this is very much the case- midwives are highly trained, regulated and free to Ontarians. Midwives offer home, hospital and we are starting to see some new birth centres as well for deliveries. But midwives only deal with 'typical' cases- vertex, singleton, up to 42 weeks. (although some offer shared care in twin situations, they will take VBAC, and it depends on the practice as to whether they will 'allow' HBAC. ) A study of midwifery in Canada showed that our home birth infant mortality rates are very comparable to hospital rates.

 

However, I think this is only part of the equations. we also have to explore *why* women are choosing to have breech or twin births at home, or HBACs with midwives who don't have perhaps as much training as they could....and the reasons are largely because they *know* that csection is the only option available for them at the hospital, even though there is plenty of evidence that VBACs and c sections both carry risks, that automatically sectioning in twin births confers no benefit, and even in breech births, the outcomes of the Hanna study have been called into question over methodology leading the conclusion to be that no one is really sure if it is that much safer to have a csection for a breech or not. Obstetricians, the birth 'specialists' are so risk averse that they are unwilling to offer a trial of labour in these scenarios. so women, stuck between an automatic cesarean birth vs. a risky home birth, choose the home birth. the much better option, of course, would be to be able to birth at the hospital with a knowledgeable, supportive OB who would support vaginal birth in these situations. But unfortunately for women, these doctors are few and far between.

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#3 of 29 Old 02-15-2014, 05:22 PM
 
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The MANA stats article shows a pretty clear increased rate of neonatal mortality for home births when certain risk factors (breech, VBAC) are present.

What percentage of midwives from the MANA study attended these higher- risk births at home? Is it a handful of midwives
attending these births? Is it 50%? is it 90%?

If the study is trying to state that women who are low risk have "congruent" outcomes with hospital births, does this conclusion even matter if the midwives in the study don't limit their practices to only low- risk women?

Isn't this "evidence"? Aren't midwives those pushing for "evidence-based practices"? What about when the evidence comes from their own data? Shouldn't that influence the practice of midwifery even more?
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#4 of 29 Old 05-02-2014, 04:51 PM
 
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I'm in no way as knowledgeable in the statistics/studies of HB, but the last thread on the recent study kind of blew my mind. I have 5 children, and my last 3 were born at home. All along, the only information I have ever seen has said that hb is as safe as hospital birth. OP, in your opening post, can you give those numbers in more lay terms? I'm assuming the outcome is better once the breech and twins, ect. are taken out of the equation; how much better?

I have found HB to be more safe than my BC birth and more comfortable than my birth in our truck, lol. Anyway, just hoping to better understand...

Also, I totally agree with post#2. It was a traumatic mismanaged miscarriage that led me to look for options other than my local hospital and then the highhandedness of the staff at the hospital my truck-birth (lol) was transferred to that led me to seek HB. Had I had more empathetic experiences I probably would have been just any other go-with-the-flow mom.


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#5 of 29 Old 05-05-2014, 05:49 PM
 
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 What if women had the option of birthing anywhere they wished with well trained midwives?

 

I wish that's how it worked! 


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#6 of 29 Old 05-05-2014, 06:44 PM
 
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 What if women had the option of birthing anywhere they wished with well trained midwives.

 

No matter how open the system is, I think it also needs to be acknowledged that some pregnancies and some labors are outside the scope of practice of midwives, and that some women will, therefore, be appropriately risked out of midwifery care.

 

Quote:
 What if hospitals were a place where women could go to birth and feel respected; where they were able to make informed decisions about the care they received? I think that if we have more midwives practicing in hospitals, we will see the climate change in these places.  I have seen this in hospitals around my area.  Those that have a higher percent of deliveries done by CNMs are far more mother/baby friendly.  Others that have no midwives practicing have >40% c-sec rates!

 

 

FWIW, my experience with hospitals in pregnancy was that I was respected, and able to make informed decisions.  (Ironically, the thing that most helped me make those informed decisions was the epidural.  The epidural helped me stay coherent, calm, and articulate at a time when I otherwise think I'd just have been out of my head.  Pre-epidural labor hurt a lot.)  At least some hospitals are doing this right.

 

I would also advise caution in interpreting c-section rates.  For my second birth, I chose a practice of CNMs at a small hospital with a very low c/s rate, and a great reputation for natural birth.  At 29 weeks, I had some bleeding and came in... and was promptly loaded into an ambulance and sent to a hospital with nearly twice the c/s rate because my darling, natural-birth friendly hospital didn't have the staff or facilities to handle my complication safely.  I had gone looking for a natural birth friendly facility, and what I had actually found was a low-resource facility.  The hospital that delivered my daughter has a high c/s rate because they take high-risk transfers from all over the state, and from border regions of a few others.  Their c/s rate seemed appalling to me when I looked at just the number, but when I started to understand that hospital's place in the overall system, it made a lot more sense.

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#7 of 29 Old 05-11-2014, 05:52 AM
 
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Yes, OP, great post. I would add to the wish-list "What if hospitals received homebirth transfers with professionalism and that MW's did not see hospitals as a threat to their profession in transferring".  Of course this can be worded in many ways depending on your perspective. I had a HB in two states - one a bit more open midwifery. Towards the end of my pregnancy in the state that is not especially open to HB, it occurred to me that I was in increased danger because of that. Ultimately if I needed a transfer and was not advised to transfer or if there was hesitation I would first and foremost have placed responsibility on my MW. On and individual level, that makes sense to me, however, stepping back I think the system plays a role for sure. 

 

Also, as HB consumers we play a role here too. When we look for MWs we can ask good questions about transfers. A transfer rate that is too low can raise some questions about that. One that is high - may be a good sign. With my first birth a MWs transfer rate was a significant question and in an area with a lot of first-time mothers having HB, I wanted a MW with a chunky transfer rate. Because I didn't mind the idea of transferring for pain meds or other non-emergent reasons. That's part of what hospitals are for after all. 

 

I do think the "homebirth at all costs" (or even "unmedicated at all costs") idea is pretty damaging. It's hurtful for women when they don't have the birth they planned and this idea that we can control birth is regretful, IMO.  I prefer the idea of "home until I need the hospital".  

 

Another thing that I don't know too much about  but that feels related are the regulations placed on MWs. I think in CA midwives can't give an IV of fluids. My first HB was in CA and I transferred for fluids. I'm glad I did but I also think about how different that birth would have been had my MW been able to give me fluids early in labor. I read an article about a CPM that discussed why she chose to not go for a CNM and it had to do with limitations on care. 

 

From my readings there also seemed to be some concerning stats on infant care after the birth. That ended up being a big factor for us and I adjusted my child's birth and care after the birth because of what I had read. Many HB parents choose to have the MW do the first infant visits. I chose to haul myself and baby into the pediatrician - hard as it was to leave my nice bed. ;-)  

 

So much to consider!! 

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#8 of 29 Old 05-14-2014, 09:40 AM
 
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IdentityCrisisMama, can you lead me to the stats on infant care after the birth? I am planning for a home birth right now, and while last time we went to the pediatrician at day 2 (after a birth center birth), I was planning to avoid that. this time around. I'm curious to know if that is ill-advised. 

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#9 of 29 Old 05-14-2014, 09:49 AM
 
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I wish I could. My reading was from the recent studies that were out almost 4 years ago (that was the time of my last HB).  Maybe someone can help with the language the PP would use to search for outcomes related to the period after birth - one month?  That was the time period I was looking at, I think. You could also ask your MW to see if she has any insight. Of course there's also the crazy "old fashioned" idea of asking your pediatrician if she/he will come to you. I wish that was still common. Sorry I couldn't be more help. 


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#10 of 29 Old 05-14-2014, 06:05 PM
 
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Even if you can just find a family practice doc to come out to you in the first 48 hrs.  We have some in out area that will do this but it is out of pocket. 


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#11 of 29 Old 05-23-2014, 10:41 PM
 
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"I would also advise caution in interpreting c-section rates. "

 

For CPMs who are keeping their stats through MANA, a transfer that results in Cesarean would count in the midwife's Cesarean rates. 


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#12 of 29 Old 05-24-2014, 04:53 PM
 
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Yes where I am in Canada there was no option to even try vaginal birth even for frank breech. I decided that if my baby trend out to be breech I would still labour at home, and since mw's aren't allowed to attend these births id do unassisted. As it turned out she wasn't breech. I find it very disturbing that a woman is forced to choose between no medical assistance whatsoever or major surgery that has been shown to not improve outcomes. I mean it's my life on the line, and that is my child, anyone who wants to tell me I have to get cut can f**k off!
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#13 of 29 Old 05-27-2014, 10:02 AM
 
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Yes where I am in Canada there was no option to even try vaginal birth even for frank breech. I decided that if my baby trend out to be breech I would still labour at home, and since mw's aren't allowed to attend these births id do unassisted. As it turned out she wasn't breech. I find it very disturbing that a woman is forced to choose between no medical assistance whatsoever or major surgery that has been shown to not improve outcomes.

 

I'm not sure what you mean that c-section for breech has been shown not to improve incomes. Significantly less breech babies die or are injured when delivered by c-section. The study talked about in this article (http://www.guttmacher.org/pubs/journals/2710501.html) showed that "breech...infants scheduled to be delivered by cesarean section are 77% less likely to die and 64% less likely to experience serious neonatal health problems than are those scheduled to be delivered vaginally."

 

In the data released by MANA just a couple months ago, they reported that for the breech babies born at home "Of 222 babies presenting in breech position, 5 died either during labor or the neonatal period." That's a rate of almost 22.5 deaths per 1000 babies born. Breech babies born in the hospital have a rate of 0.8/1000. So breech babies born at home died at a rate 28 times higher than those born in the hospital. All of the breech babies born at home were born vaginally, and most of the ones in the hospital were probably c-section.

 

With those numbers, I just can't see how you say c-section has been show "to not improve outcomes" for breech babies. It certainly has been shown to improve outcomes for them.

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#14 of 29 Old 05-27-2014, 01:22 PM
 
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http://m.theglobeandmail.com/life/parenting/c-section-not-best-option-for-breech-birth/article597103/?service=mobile

ETA: given the above, and that knowledge isn't static, and that it's my life and that of my baby on the line, I probably wouldn't agree to have a major surgery essentially for nothing. That's my decision to make, too bad hospitals wouldn't respect that. Is rather birth at home in peace and without violence then go to the hospital to be birth raped. Thanks
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#15 of 29 Old 05-27-2014, 05:11 PM
 
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What's your opinion on the MANA breech stats?

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#16 of 29 Old 05-27-2014, 08:20 PM
 
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Me? That the manner in which they were gathered probably wouldn't withstand serious scientific scrutiny. I wonder if the stats from countries where they don't automatically section for breech (like France) have the same findings, somehow I seriously doubt it.

IMO there are other factors at play, specifically thy doctors are more likely than ever to race to the knife to avoid exposure to litigation.

Either way, if I was no given an option and was forced to have a c-section despite expressing that I thought it was too risky and something catastrophic happens, I would sue for every single last penny possible.

ETA:

http://www.salon.com/2013/09/22/whats_behind_the_rise_in_c_sections/
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#17 of 29 Old 05-28-2014, 08:15 AM
 
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Me? That the manner in which they were gathered probably wouldn't withstand serious scientific scrutiny. I wonder if the stats from countries where they don't automatically section for breech (like France) have the same findings, somehow I seriously doubt it.

 

The study referenced in the first article I posted (http://www.guttmacher.org/pubs/journals/2710501.html) was an international study, involving women in 26 countries. Women (whose babies were either frank breech or complete breech) were randomly assigned vaginal birth or c-section.

 

After the study was published, the c-section rate in the Netherlands increased. This page explains that "A recent retrospective observational report reviewed neonatal outcome in the Netherlands before and after the publication of the Term Breech Trial (8). Between 1998 and 2002, 35,453 term infants were delivered. The cesarean delivery rate for breech presentation increased from 50% to 80% within 2 months of the trial's publication and remained elevated. The combined neonatal mortality rate decreased from 0.35% to 0.18%, and the incidence of reported birth trauma decreased from 0.29% to 0.08%. Of interest, a decrease in mortality also was seen in the emergency cesarean delivery group and the vaginal delivery group, a finding that the authors attribute to better selection of candidates for vaginal breech delivery."

 

In other words, the c-section rate went up, and the neonatal mortality rate was cut in half. The birth trauma rate was cut to 1/4 of what it had been. And there was also a decrease in the death rate of babies for those who delivered vaginally or had emergency c-sections.

 

I think that this last finding is interesting, and important - the death rate for vaginal deliveries decreased as well when not all breech deliveries were treated the same by mothers and doctors, and mothers chose c-section or vaginal delivery based on the risk factors specific to them. This meant that if a medical team said it was safe for them to try a breech vaginal delivery, great! It also meant that many women were told that for them, c-section would be safer for their baby. And they chose that. And when both of those interactions kind of happened, the death rate decreased.

 

I agree with you that absolutely we, as women, have the last word on what happens to our bodies. We decide whether we do a c-section or a vaginal delivery. But we also can't ignore scientific evidence about the safety of different choices based on personal factors of our own bodies and pregnancies - like our pelvis shape, our baby's exact position, our baby's size - we have to take all of that into account, too. We can't just close our eyes to the number and pretend they don't exist. We have to confront them head on and figure out how to make them better for women and babies.

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#18 of 29 Old 05-28-2014, 09:00 AM
 
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Interesting

I agree, we do not have to defer to the stats and we are not morally obligated to take the least risky path. Certainly we should not be forced to undergo major surgeries where there is evidence of minimal increase in risk (doubling a very small number leads to another very small number, even though the risk is "halved" as you up it).

I also think it's terribly naive to think the doctor is all benevolent, they have their own interests, which is partly why mothers are always the best persons to make these decisions.

And the stats keep changing, god knows what they'll say in 10 years from now about this topic.
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#19 of 29 Old 05-29-2014, 05:23 AM
 
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I find it interesting (maybe even amusing) that the MANAstats study is touted as evidence to support OOH birth when we like the data, but "wouldn't withstand scientific scrutiny" when we don't like the data.

I've asked and pillowy has asked - and one one has answered. I'll answer:

The MANAstats data regarding planned breech delivery with CPMs at home births are deplorable.

So what is MANA going to do about it? This is their own data.
What are CPMs doing to do about it? These numbers reflect the collective practices of certified professional midwives.

Usually when we know better, we do better. There's been hardly a whisper of concern from CPMs regarding attending high risk births -such as breech - at home. Why is MANA ignoring its own evidence?
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#20 of 29 Old 05-29-2014, 10:53 PM
 
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Hmm, imagine if the protocol for a woman with breast cancer was to only offer medical assistance if the patient choose the treatment that carried the lead statistical risk. So, say I had breastcancer and my doctor said that a double mastectomy doubled my chances of survival and therefore it would be immoral for them to offer me any other treatment options and sure, i can always go ahead and try whatever alternative treatments I can muster without the assistance of the entire licensed medical establishment but none who are licensed would help me with anything other than the best, least risky option. I'm guessing we'd find that deplorable. Yet here we are, having yet another tiring conversation that's ultimately about women's autonomy and their rights to make decisions about their own bodies. And from what I can tell we r mostly women arguing about these things, the men don't have to try very hard to oppress us, do they? We just do it all for them. Anyway, who cares what either stats say? It's none of anyone's business what I do with my body. It's mine, my body, and if I am pregnant that doesn't in any way diminish or change that it's my exclusive right to do with it as I see fit. End of story.
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#21 of 29 Old 05-30-2014, 08:49 AM
 
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Hmm, imagine if the protocol for a woman with breast cancer was to only offer medical assistance if the patient choose the treatment that carried the lead statistical risk. So, say I had breastcancer and my doctor said that a double mastectomy doubled my chances of survival and therefore it would be immoral for them to offer me any other treatment options and sure, i can always go ahead and try whatever alternative treatments I can muster without the assistance of the entire licensed medical establishment but none who are licensed would help me with anything other than the best, least risky option. I'm guessing we'd find that deplorable. Yet here we are, having yet another tiring conversation that's ultimately about women's autonomy and their rights to make decisions about their own bodies. And from what I can tell we r mostly women arguing about these things, the men don't have to try very hard to oppress us, do they? We just do it all for them. Anyway, who cares what either stats say? It's none of anyone's business what I do with my body. It's mine, my body, and if I am pregnant that doesn't in any way diminish or change that it's my exclusive right to do with it as I see fit. End of story.
The stats matter because we aren't fully autonomous unless we're making fully informed decisions.
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#22 of 29 Old 05-30-2014, 10:49 AM
 
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I totally agree pp. The stats matter insofar as they're necessary to make informed decisions. But we r not mere automatons who have to defer to the stats, or at least we shouldn't be. I guess with breech births we are as major surgery or no medical assistance appears to be the only choices, despite that the chances of a good outcome are very good with breech vaginal delivery (according to the stats pillowy cited there's a 99.65% chance of survival).
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#23 of 29 Old 05-30-2014, 02:18 PM
 
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Yet here we are, having yet another tiring conversation that's ultimately about women's autonomy and their rights to make decisions about their own bodies.
No, this discussion isn't about women's autonomy. That's not what it's about at all. We all agree that women should have the authority to make the decisions for themselves.

What my issue is is that the system of homebirth in the US, as it currently stands, is being shown over and over (in multiple studies) to be unsafe. I think we need to figure out exactly WHY that is - lack of midwife education? lack of midwife regulation? lack of needed equipment? poor integration with the ob and hospital system? midwives following non-evidence based practices? - and change it. When women decide to have their baby at home, they should be able to know that there is a safe system for doing so.

Personally, I think a huge part of the issue is the irregularity and inconsistency in midwife education and training. Some homebirth midwives know what they're doing and also know when to transfer, and moms and babies are safe in their hands. Other midwives do not know when to transfer or to handle emergencies or even to recognize emergencies - and that puts mom and baby in danger. And how are we supposed to know which group our midwife falls into? There is no clear or official way to view a midwife's full record.

Again, this isn't about whether women should be able to make their own choices. We all agree that they should. This is about making every option safer for women.
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I personally don't think we can talk about making birth safer without discussing autonomy. Talking about making birth safer must include a discussion of options, which fundamentally implicates autonomy. I guess I just get nervous whenever people talk about making it safer because usually there's some who chime in that options should be reduced to make it "safest".

This has been such an interesting discussion. Thank you pillowy for being so reasonable
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#25 of 29 Old 06-02-2014, 05:57 AM
 
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Quote:
Originally Posted by krst234 View Post


I've asked and pillowy has asked - and one one has answered. I'll answer:

The MANAstats data regarding planned breech delivery with CPMs at home births are deplorable.

So what is MANA going to do about it? This is their own data.
What are CPMs doing to do about it? These numbers reflect the collective practices of certified professional midwives.

Usually when we know better, we do better. There's been hardly a whisper of concern from CPMs regarding attending high risk births -such as breech - at home. Why is MANA ignoring its own evidence?
I hope that midwives are not simply ignoring the breech stats. They were.... horrifying. I know the sample size was small, which isn't good for statistics, but it is the information that we have at this time. I actually am relieved to have this information as it helps me to inform my practices.

Here is the deal, when women interview me, it is VERY often that they want to be sure that I will do breech births, that I will do births past 42 weeks, that I will catch twins and triplets, that I will do births if their membranes have been ruptured for 7 days or whatever. I love having statistics available to help show women why I have written my practice guidelines the way that I have. To show women that, based on our own statistics, breeches are not just a "variation of normal" but are instead a position that comes with a (much) greater risk to the baby helps them to make an informed decision.

I know I haven't heard a ton of talking about the breech statistics of the MANA study, but to be honest, there were lots of midwives that I spoke to who had no idea that MANA had released their numbers.

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

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#26 of 29 Old 06-02-2014, 10:52 AM
 
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@MidwifeErika - I don't understand why you'd use stats that you admit are statistically flawed when there are more accurate stats available.

If 3-4% of babies are breech isn't that by definition a variation of normal?

Do the Mana stats different between the different kinds of breech? I believe there's consensus that footling is more risky than frank. As someone who has seen videos of natural delivery for frank breech I would be surprised if the risk was significantly greater than for a regular vaginal delivery.

I don't understand what professionals would prefer stats that everyone admits are seriously flawed (self reported, small N) for soemthing so important that will almost certainly have implications for women's autonomy - for women to be able to say NO TO A Major surgery.

To me if we are at all going to limit a persons autonomy we should have the best stats to support that and indisputable evidence of a risk that in of itself is too great. Having a 99+% change of a favourable outcome should never be that case.
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#27 of 29 Old 06-02-2014, 06:42 PM
 
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What are the "best stats"? What do you have to offer for large studies that show that vaginal breech is safer? Even the SOCG guidelines Viola P linked to above, in defense of vaginal breech birth, starts their recommendations that vaginal breech births are more risky than c/s, but properly selected candidates (ie the variations of type of breech, size of baby and pelvis estimates, etc) and in a properly equipped medical center (ie not home). I doubt there will ever be a gold standard randomized study, so this is what we've got for now.

I don't think MANA can "do anything" about these statistics because for many people I think autonomy is more important than risk-based decision-making. Certain people are totally safer and better off being at home, and IMO those people should give birth at home! But if we want statistics to reflect the safety of birthing at home, we have to be open to the idea that some people are not safer at home, such as breeches or perhaps VBACs or twins as other research suggests. Yes, some discussions of autonomy lead to UC- because women can refuse doing something they see as too risky (ie going to the hospital) based on gut feeling/instinct/belief in "nature", just as a birth attendant can refuse doing something they see as too risky (catching a breech baby) based on statistics.
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#28 of 29 Old 06-03-2014, 06:21 PM
 
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Breech is a not uncommon thing, but that doesn't mean it's trivial. And of course breech births in online videos look easy - when a birth goes to hell in a fast car, does your friend with the camcorder keep taping, and if she does, would you post it?

It's not my impression that professionals "prefer" the MANA stats. It's just that, however flawed they are (and they are certainly flawed), they're the best information we have on the outcomes of homebirth as it is actually practiced in the United States. It would be dishonest to tell people to ignore those statistics unless we can offer some better dataset on those births. We don't have one. (If midwives were to agree to stringently report all outcomes to a governing body of some kind, we could have one pretty quickly, but there are a lot of midwives who are opposed to that.)
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#29 of 29 Old 06-03-2014, 07:50 PM
 
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Variations of normal are just that, variations and should be treated with more caution than normal, low risk births.
I'm not sure where you live in Canada, VioletP, but when Bean was possibly breech they said I could still do vaginal, but that a home birth was not recommended.
I think some of it comes down to trusting your health care professional.
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