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#31 of 54 Old 10-12-2008, 09:55 PM
 
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Another thing to consider is that hospital stats include extreme life-saving measures that not all homebirthers or UCers would necessarily choose for their babies. If a baby is very ill or iatrogenically damaged and kept alive by artificial means, and eventually dies, at what point does that no longer count as a perinatal death?
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#32 of 54 Old 10-12-2008, 10:08 PM
 
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You're never going to get two perfectly balanced groups. It's impossible. This is a problem with any study. That is why they have limitations. Also, I know there are some people who lurk and UC with sucessful outcomes and never post. Some UCers are kind of shy about their private lives, YKWIM? Some don't care about being on the birth rolls. So I just used the information we already had. Maybe it is not perfect, but it is more information than we had before.
I wonder if you could ask lurkers to PM or email you with their birth stats to be added to the calculations, without publicising their birth stories.

Also, if you're looking for a control group, there are plenty of MDC mamas who have midwife-attended home births who may have posed in the Homebirth forum- there might be a way to compile their statistics as well.

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#33 of 54 Old 10-13-2008, 03:28 AM
 
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Originally Posted by fourlittlebirds View Post
Another thing to consider is that hospital stats include extreme life-saving measures that not all homebirthers or UCers would necessarily choose for their babies. If a baby is very ill or iatrogenically damaged and kept alive by artificial means, and eventually dies, at what point does that no longer count as a perinatal death?


Plus, do you count the deaths if the mother transferred to the hospital? Doesn't that then make it a hospital birth and NOT a UC? I think two of the mothers from our group ended up going to the hospital and having their babies there. Wouldn't that make it not part of the UC stats since the babies did not die at home during a UC? I think if the babies were lost during the home birth that it would count only then. Otherwise it's technically a hospital birth.

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#34 of 54 Old 10-13-2008, 08:56 AM
 
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I think that would depend upon the reason for the death.

I've had two midwife-attended births before my UCs.

The first resulted in transfer and immediate c-section (for malpresentation, but really for caregiver distress, long story, it may give an idea to mention that I somehow chose a midwife who didn't know how to express her milk- I had to give her instructions while I was in labor).

The next went beautifully, with a very different (hands-off, very experienced) midwife. I am not the only ex-client of this midwife to go UC with further births (after she had retired).

I wish that there were some way to realistically get data for UC or all homebirth VBACs vs highly managed VBACs or scheduled repeat c-secs (where there is no reason for the repeat c-sec more than a previous c-sec, as in my case a section for malpresentation or another non-repeating (and valid) reason).

And again, just putting it out there, but my last birth was UC with immediate hospital transfer, and I did write a birth story shortly thereafter. I don't consider it to be a poor outcome though, his labor and birth went great, but I needed care just after, and for a couple of days. So, to me, the UC was successful, but then I had a complication which didn't involve the baby. He never left my chest in the 3 days' hospital stay, just as would have happened at home. So my goal (of a healthy, unmolested baby) was met, even though I had a bad hospital experience (not due to UC, as I had had prenatal care with a perinatologist at UCDavis so the "oops" card was exceedingly easy to play).
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#35 of 54 Old 10-13-2008, 12:39 PM - Thread Starter
 
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This discussion has gone on without me, which is wonderful. I didn't think I would be starting such a controversy. Truly, while I do not believe the adage "statistics are meaningless" I would not give them too much significance or seek to live life and make decisions based only on statistics. I only compiled them to give a little perspective to those trying to decide whether to UC or not. When I hear negative stories about UC and bad outcomes, I can feel my faith in the rightness of unassisted birth wavering. It's easy to get caught up the negativity and fear-mongering surrounding surrounding birth these days. I want mothers to be able to UC with confidence. I think it's important to realize that something *could* go wrong, make a list of fears/complications, and make an action plan to go with each one. Then once you have educated yourself and done everything possible to make sure you can handle whatever problems might arise, realize that a part of it is out of your hands and make peace with that. If you can't do that you shouldn't UC. IMHO.

I'm really impressed by the intelligent and thoughtful responses I've read here. I've been enriched by being a member of this forum and getting to know and hear from each of you. Thanks to all

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#36 of 54 Old 10-13-2008, 12:46 PM
 
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Originally Posted by amberskyfire View Post


Plus, do you count the deaths if the mother transferred to the hospital? Doesn't that then make it a hospital birth and NOT a UC? I think two of the mothers from our group ended up going to the hospital and having their babies there. Wouldn't that make it not part of the UC stats since the babies did not die at home during a UC? I think if the babies were lost during the home birth that it would count only then. Otherwise it's technically a hospital birth.
I would call that a "planned UC turned hospital transfer" and include it in the UC statistics.

A big part of why UC is safe is that women listen to their gut instincts and transfer care if something is wrong. To exclude hospital transfers from the stats would artificially inflate the safety- as most women with complications will find themselves in hospitals, and the healthy, normal moms and babes have stayed at home.

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#37 of 54 Old 10-13-2008, 01:50 PM
 
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The MDC roll call stats are not statistically significant in any way, for the purposes of determining mortality rates. I'm surprised that some people are using them to claim that UC has a 20x higher mortality rate than CNM-attended hospital birth, since the data collection can even hardly be called such.

There is another collection of UC data on Unhindered Living, with a sample size of about 200, that has no infant or maternal deaths at all. So using that, you could argue that any deaths at all in a hospital are unacceptable, since UC has a zero death rate! (Ridiculous, of course, but so is using the MDC data to claim that the death rate is X amount and compare it to well-studied mortality rates among hospital-based CNMs).

Basically, we cannot use either UC data set to make any kind of accurate conclusion about the mortality rates of unassisted births. In order to do that with any kind of accuracy, you'd need a large prospective study with many thousands of women planning UCs who you followed from pregnancy to several weeks or months postpartum (similar in design to the CPM2000 study in the BMJ). You'd need to gather detailed information about their health histories, any "risk factors," their pregnancies, their prenatal care (self and professional), their labors and births, etc.
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#38 of 54 Old 10-13-2008, 02:12 PM
 
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Add one more for me! My 2005 UP/UC was a full UP/UC w/ no transfer and everyone was/is wonderful w/ no complications.

dizzy.gif DS1: 10/89 - DD1: 06/94 - DD2: 02/97 - DS2: 12/05 - DS3: 12/08 - DC6: ETA 04/26/12

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#39 of 54 Old 10-13-2008, 05:24 PM
 
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Originally Posted by fourlittlebirds View Post
Another thing to consider is that hospital stats include extreme life-saving measures that not all homebirthers or UCers would necessarily choose for their babies. If a baby is very ill or iatrogenically damaged and kept alive by artificial means, and eventually dies, at what point does that no longer count as a perinatal death?
Hmm, yes, you could potentially keep the child on a machine until the period of recording has passed, then allow the child to die.

Mama to expecting Babe 2
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#40 of 54 Old 10-16-2008, 06:54 AM
 
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I think what we have here is a very interesting, very valid set of statistics.
but I wouldn't extrapolate them to make statements about the relative merits or safety of UCing compared with hospital birth.
What we have is statistics that show, in women who post their birth stories on the MDC UC board, UCing is very safe

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#41 of 54 Old 10-16-2008, 07:26 AM
 
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I find it interesting how many posters just in this thread had VBAC UC's (including me). Maybe instead of making up statistics, that blogger should consider what pushes so many "high risk" VBAC women to choose to give birth unassisted.

mom to all boys B: 08/01ribboncesarean.gif,  C: 07/05 uc.jpg, N: 03/09 uc.jpg, M: 01/12 uc.jpg and far too many lost onesintactlact.gifsaynovax.gif

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#42 of 54 Old 10-16-2008, 02:53 PM
 
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mine is the the stillbirth where he was gone a day or two before hand. I *had* to post the story immediately. I was proud of my uc. I *still* DID IT even though the outcome was crappy.

Can't wait to see you again Micah Zachary who would have been six months old on monday.

It's called taking RESPONSIBILITY. it's a lost art in today's world. I think most uc'ers have that attitude or we wouldn't be ucing.

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#43 of 54 Old 10-16-2008, 04:51 PM
 
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We should start an actual study sticky thread (or a private statistic PM thing.) where women can register that they are:
1. planning a UC.
2. Whether or not they are recieving professional prenatal care.
3. C-section history
4. Age
5. # of previous pregnancies/births
6. support of family/partner?
7. Previous Traumatic hospital birth?
8. Gestational diabetes?
etc.

And ask these women if they will agree to participate in the study and to register the birth outcomes here.

what do you ladies think?

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#44 of 54 Old 10-16-2008, 04:55 PM
 
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Thank you, Cuddlebaby, for courageously sharing your story. Yes, you should be proud of your birth! One statistic that I rarely see mentioned is the fact that every 15-20 minutes a baby is stillborn in an American hospital. This is double what it was 10 years ago. Many of these babies I'm sure would have died regardless of where they had been born. But some deaths may be a result of being summoned prematurely via inductions and c-sections. A stillbirth at home is nearly always questioned, especially by those who want to prove the dangers of homebirth. But how many of those people question a stillbirth at a hospital?
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#45 of 54 Old 10-16-2008, 07:30 PM
 
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Originally Posted by Cuddlebaby View Post
mine is the the stillbirth where he was gone a day or two before hand. I *had* to post the story immediately. I was proud of my uc. I *still* DID IT even though the outcome was crappy.

Can't wait to see you again Micah Zachary who would have been six months old on monday.

It's called taking RESPONSIBILITY. it's a lost art in today's world. I think most uc'ers have that attitude or we wouldn't be ucing.

thank you for sharing that you're an inspiration

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#46 of 54 Old 10-16-2008, 08:31 PM
 
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It's called taking RESPONSIBILITY. it's a lost art in today's world. I think most uc'ers have that attitude or we wouldn't be ucing.
I couldn't agree more. I was railroaded into my UC by the system, but in retrospect I am so very glad I was able to have one (I finally pm'd fourlittlebirds about it the other day).

I'm still so so very sorry for your loss
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#47 of 54 Old 10-16-2008, 09:51 PM - Thread Starter
 
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Originally Posted by WannaBeAMamaMia View Post
We should start an actual study sticky thread (or a private statistic PM thing.) where women can register that they are:
1. planning a UC.
2. Whether or not they are recieving professional prenatal care.
3. C-section history
4. Age
5. # of previous pregnancies/births
6. support of family/partner?
7. Previous Traumatic hospital birth?
8. Gestational diabetes?
etc.

And ask these women if they will agree to participate in the study and to register the birth outcomes here.

what do you ladies think?

We need a way to verify that the mothers who are submitting the data are real people.
I like the idea though!

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#48 of 54 Old 10-19-2008, 12:28 AM
 
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This is one of the next projects I'd like to work on, after I finish my PhD dissertation about unassisted birth this semester. I need to find some people to collaborate with who have experience in conducting quantitative studies on birth outcomes, in order to start a prospective study of UC (similar in design to the CPM2000 study, but with additional questions to reflect the unique circumstances of UC). It would probably take several years to gather enough numbers to have statistical significance, but I think it's important to have accurate information on the outcomes of UC, the health histories of women who do them, etc.

It would be a really big undertaking and would need to be done right, but I think it can and should be done.
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#49 of 54 Old 10-19-2008, 02:10 AM
 
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that sounds like a wonderful and important project rixafreeze. i would love to help when you get around to it.

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#50 of 54 Old 10-19-2008, 05:16 AM
 
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Originally Posted by Cuddlebaby View Post
mine is the the stillbirth where he was gone a day or two before hand. I *had* to post the story immediately. I was proud of my uc. I *still* DID IT even though the outcome was crappy.

Can't wait to see you again Micah Zachary who would have been six months old on monday.

It's called taking RESPONSIBILITY. it's a lost art in today's world. I think most uc'ers have that attitude or we wouldn't be ucing.
Thank you for sharing your story.Seeing the stories like yours actually helped me realize my UC because of the responsibility factor.

joy.gifme, herding 5 critters a cat and a dog. DS 11/01, DS 10/04, DD 2/06, DS 5/07 and DD 9/10

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#51 of 54 Old 10-19-2008, 04:32 PM
 
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Rixa, you know I'm on board with that! BTW, tomorrow I defend my thesis.

M.Ed. Mama to Chunka (1/07), Beauty (5/09) and Elizabear 3/12): Birth Doula (working toward certification) AAMI Midwifery Student, Advocating with Solace for Mothers & The Birth Survey

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#52 of 54 Old 10-19-2008, 11:08 PM
 
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Yay! Good luck on the defense. Isn't it nice to finally have it DONE?
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#53 of 54 Old 10-20-2008, 01:25 AM
 
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Originally Posted by rixafreeze View Post
This is one of the next projects I'd like to work on, after I finish my PhD dissertation about unassisted birth this semester. I need to find some people to collaborate with who have experience in conducting quantitative studies on birth outcomes, in order to start a prospective study of UC (similar in design to the CPM2000 study, but with additional questions to reflect the unique circumstances of UC). It would probably take several years to gather enough numbers to have statistical significance, but I think it's important to have accurate information on the outcomes of UC, the health histories of women who do them, etc.

It would be a really big undertaking and would need to be done right, but I think it can and should be done.

in all there was plenty of criticzem of the CPM 2000 study- their adjusted infant mortality for term pregnancy 37 weeks + was 1.7 per 1000- their raw data had a higher number- but still close to the national average for term pregnancy-
which is different than our national total infant mortality, preterm under 32 weeks gestation accounts for over half the infant mortality stats for our country - so the 6.78 per 1000 stat is high- the national number is closer to 2-3/1000 term births which is .003%----and the stats from the top of the page--- UC infant mortality was .8%
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#54 of 54 Old 10-21-2008, 04:19 PM
 
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[QUOTE=mwherbs;12423452]in all there was plenty of criticzem of the CPM 2000 study- their adjusted infant mortality for term pregnancy 37 weeks + was 1.7 per 1000- their raw data had a higher number- but still close to the national average for term pregnancy-
which is different than our national total infant mortality, preterm under 32 weeks gestation accounts for over half the infant mortality stats for our country - so the 6.78 per 1000 stat is high- the national number is closer to 2-3/1000 term births which is 1 death out of every 500-333 births -and the stats from the top of the page 4/485 or 1 death out of ever 121 births
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