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<div>Originally Posted by <strong>*MamaJen*</strong> <a href="/community/forum/post/15579728"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a></div>
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Basically, yes. It's hard to tell exactly where those high neonatal numbers are pulled from. That's the frustrating thing. They give a list of 12 studies they analyzed -- three from Canada (1998 - 1999; 2003 - 2006; and 2000 - 2004); two from the Netherlands (1990 - 1993 and 2000 - 2006); two from the U.S. (1976 - 1982 and 1989 - 1996, and note that the big North American homebirth study is not in there); two from the UK (1978 - 1983 and 1994); one from Western Australia (1981 - 1987), one from Switzerland (1989 - 1992) and one from Sweden (1992 - 2004).<br></div>
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One of the major pitfalls of meta-analyses is that they often include even the crappy studies. As you previously mentioned, <a href="http://www.bmj.com/cgi/content/abstract/317/7155/384" target="_blank">this study</a> and <a href="http://journals.lww.com/greenjournal/Abstract/2002/08000/Outcomes_of_Planned_Home_Births_in_Washington.9.aspx" target="_blank">this study</a> are so flawed that not even ACOG reps cite them in their many statements against home birth.<br><br>
Hence, we have this new "me-too" meta-analysis, which I consider to be little more than an attempt for ACOG and its minions to legitimize their <a href="http://articles.baltimoresun.com/2008-07-13/news/0807110120_1_home-birth-home-deliveries-birth-tub" target="_blank">relentless quest to force childbearing women into hospitals.</a> In fact, they're gearing up to lobby against our birthing rights, (detailed in last link), so don't think the timing of this publication was an accident.<br><br>
This "meta-analysis" is, in fact, only a "quasi-analysis" in that it cherry picks which studies to consider. <a href="http://www.bmj.com/cgi/content/full/330/7505/1416" target="_blank">The most pivotal study of them all</a> was not welcome at the table.
 

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Does this study include any explanation for their rationale on what studies to include?<br><br><div style="margin:20px;margin-top:5px;">
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<table border="0" cellpadding="6" cellspacing="0" width="99%"><tr><td class="alt2" style="border:1px inset;">If you add up ALL mortality in the study, the hospital mortality rate is actually higher than the homebirth mortality rate (and yes, the studies did match low-risk births for the hospital cohort).<br><br>
Perinatal mortality, home: 229/331,666<br>
Neonatal mortality, home: 32/16,500<br>
Perinatal mortality, hospital: 140/175,443<br>
Neonatal mortality, hospital: 32/16500<br><br>
Total mortality, home: 261/348,160 = .0007496, or .075 per thousand<br>
Total mortality, hospital: 172/208,745 = .00082397, or .0824 per thousand</td>
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Do these numbers appear anywhere at all in the study? I sure would like to see why they didn't calculate it this way.
 

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<div>Originally Posted by <strong>*MamaJen*</strong> <a href="/community/forum/post/15582377"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a></div>
<div style="font-style:italic;">So here's something really interesting. If you add up ALL mortality in the study, the hospital mortality rate is actually higher than the homebirth mortality rate (and yes, the studies did match low-risk births for the hospital cohort).<br><br>
Perinatal mortality, home: 229/331,666<br>
Neonatal mortality, home: 32/16,500<br>
Perinatal mortality, hospital: 140/175,443<br>
Neonatal mortality, hospital: 32/16500<br><br>
Total mortality, home: 261/348,160 = .0007496, or .075 per thousand<br>
Total mortality, hospital: 172/208,745 = .00082397, or .0824 per thousand<br><br>
So there you have it.</div>
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<div>Originally Posted by <strong>*MamaJen*</strong> <a href="/community/forum/post/15579728"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a></div>
<div style="font-style:italic;">To find the perinatal death number, which was similar to the hospital mortality rate, they combined six studies, for a total of 331,666 births. So obviously, the Dutch study and five others.<br>
To find the neonatal death, which was higher, they combined the remaining seven studies, for a total of 16,500 births. The most significantly higher number was the nonanomolous neonatal death rate, which was pulled from 6 studies amounting to 15,662 births. There were 23 deaths in that group.</div>
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Sounds like they shuffled the studies in different configurations until they could flub it into looking like it "supported" their predetermined conclusion.<br><br>
When all else fails, manipulate the data.
 

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<div>Originally Posted by <strong>loraxc</strong> <a href="/community/forum/post/15584031"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a></div>
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Do these numbers appear anywhere at all in the study? I sure would like to see why they didn't calculate it this way.</div>
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Yes, the perinatal and neonatal numbers are listed in the main chart in the study. However, they didn't show that combined mortality rate, which is where you can see that the mortality actually higher for hospitals over homebirths. But getting that was just a matter of adding up the two numbers they did have for perinatal and neonatal mortality.<br>
Now, there are some subtle differences between perinatal and neonatal mortality. Perinatal mortality goes up to 7 days, while neonatal mortality includes deaths up to 30 days, so it could pick up a situation where the baby was distressed during the birth but survived a few days. However, it also starts picking up things like SIDS, which aren't related to the birth at all. Some studies account for that, others I feel are not very careful about cause of death.<br>
However, it's not like perinatal and neonatal are two totally different or unrelated numbers. There's more about them that overlaps then not.<br>
They don't explain, unless I'm missing it, where the numbers for the neonatal mortality rate came from. But if they got those 15,000 births by combining the 1980s Western Australia study, the 1990s Washington birth certificate study and a couple of others, then I would find the results totally useless.<br><br>
It would be a lot easier to discuss this study if it was readily available for everyone to read in its entirety. I feel like I'm not doing a very good job explaining this. Has anyone else actually managed to get a hold of a copy of it?
 

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Seems to me that this meta analysis highlights, in all of its flawed glory, the complete vacuum on outcomes of OoH managed births. This is especially concerning given that many US LDM/DEM/CPMs insist on maintaining high risk conditions within their practice.<br><br>
I hope that if nothing else this study and resulting controversy results in mandatory data collection on all OoH managed pregnancies/births.
 

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<div>Originally Posted by <strong>bailefeliz</strong> <a href="/community/forum/post/15585601"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a></div>
<div style="font-style:italic;">Seems to me that this meta analysis highlights, in all of its flawed glory, the complete vacuum on outcomes of OoH managed births. This is especially concerning given that many US LDM/DEM/CPMs insist on maintaining high risk conditions within their practice.<br><br>
I hope that if nothing else this study and resulting controversy results in mandatory data collection on all OoH managed pregnancies/births.</div>
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To what purpose? To prevent those of us who want options from having them?
 

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There should be better data collection, because so often, we simply don't have answers. However, "requiring better data collection" bumps into a whole host of issues.<br><br>
The problem is that the places that have shown the most consistent safety records with regard to home birth do have stringent precautions. That can mean taking options away from some women. It also means that extrapolating the results to situations without those precautions is perilous. We don't know exactly how much each of those precautions contributes to safety. Maybe some of them are unnecessary; maybe some are fundamental. It would be difficult, and in some cases unethical, to study them. We're probably never going to be able to quantify the risk of an HBAC, or HB of multiples, because there simply aren't many of them, even if you could get the concept past an IRB.<br><br>
Now, if a woman says, "home birth for me may pose a slightly greater risk but I'm willing to accept that", that's one thing. However, when we start including higher risk situations and saying that they're safe because of studies that did not include those conditions... then I think we're on trickier ground, and I do see people try to do that.
 

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I believe that mandatory data collection is critical to provide true data on outcomes---Critical for true informed consent, for scrutiny of standards of practice, to be able to effectively evaluate safety---Ultimately to promote home birth if outcomes reflect positively as in the Dutch and BC studies.<br><br>
If we all believe in safety of home birth, and safety of US OoH birth practice, there should be no hesitation to establish mandatory data collection of all OoH managed pregnancies and births. That is simply putting the same expectation of accountability and transparency on Ooh birth as exists in hospital birth. I would view any hesitancy in data collection as troubling. Any professional working with families in so vulnerable a window as birth should want data to be able to provide best and safest care to clients.<br><br>
And yes, yes, I believe the same for hospitals. It is clear to me that transparency IS evolving hospital practice, and that is a good thing. (ie--NIH VBAC consensus statement, in-hospital water birth, telemetry monitoring to facilitate mobility and unmedicated births with high risk conditions, etc.)
 

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<div>Originally Posted by <strong>Storm Bride</strong> <a href="/community/forum/post/15585844"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a></div>
<div style="font-style:italic;">To what purpose? To prevent those of us who want options from having them?</div>
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<img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/thumb.gif" style="border:0px solid;" title="thumbs up"> Exactly.<br><br>
I'm not a MW or birth professional, but have dealt with over-zealous MD's, and suffered permanent injury from misdiagnosis during pregnancy..I understand what limited choices for birth can mean.<br><br>
Legislation and regulation, IMHO, <i>rarely solves any issue</i> without creating skyrocketing costs and complications on other levels. Even midwives who are not licensed or "regulated", place a huge value on health and welfare of mom and baby...of course, in any industry-including medical or MW, you have diabolically careless people..those people should be dealt with within the law, but requiring the hoop-jumping of over-regulation for MW's, leads to some of the same flaws we have faced in the Obstetrical community!<br><br>
So many quality MW's, with years of healthy, safe, educated births have been pushed out by regulations and bans on their practices.<br><br>
This is one where it combines being an educated consumer/client, and understanding that sometimes tragedy happens in good circumstances, is a balance we all who choose to birth in any place must face. (I have the utmost respect and humility for any of you who have experienced birth/neonatal loss-I certainly don't claim to know what that pain is, so I didn't want to sound cavalier about that aspect)
 

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<div>Originally Posted by <strong>AlexisT</strong> <a href="/community/forum/post/15585868"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a></div>
<div style="font-style:italic;">There should be better data collection, because so often, we simply don't have answers. However, "requiring better data collection" bumps into a whole host of issues.<br><br>
The problem is that the places that have shown the most consistent safety records with regard to home birth do have stringent precautions. That can mean taking options away from some women. It also means that extrapolating the results to situations without those precautions is perilous. We don't know exactly how much each of those precautions contributes to safety. Maybe some of them are unnecessary; maybe some are fundamental. It would be difficult, and in some cases unethical, to study them. We're probably never going to be able to quantify the risk of an HBAC, or HB of multiples, because there simply aren't many of them, even if you could get the concept past an IRB.<br><br>
Now, if a woman says, "home birth for me may pose a slightly greater risk but I'm willing to accept that", that's one thing. However, when we start including higher risk situations and saying that they're safe because of studies that did not include those conditions... then I think we're on trickier ground, and I do see people try to do that.</div>
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The poster I was quoting seemed to specifically be talking about better data collection, for the purpose of cutting off women who are "high risk" ("risking out").<br><br>
IMO, data collection in this area is a somewhat flawed concept right out the chute. There are just way too many factors involved in pregnancy and birth for data collection to be terribly meaningful.<br><br>
I'm concerned about people comparing apples (singleton, vertex babies in mothers with no previous uterine surgery or health concerns) with oranges (breech, multiple VBAmC mama with health issues). However, the poster I was quoting talked about LDM/DEM/CPMs insisting on maintaining high risk "conditions" (ie. women) in their practice. It would appear she thinks that should stop.<br><br>
I'm sick to death of other people thinking they should have the right to decide what happens to <i>my</i> body. It makes me sick to my stomach that my failed HBA3C/stillbirth just adds to this crap...not only did my son die, but a bunch of nurses and doctors can sit back and blame "high risk" homebirth, and <i>none</i> of what's happened to me in the hospital in my previous three births will ever factor into any of that.<br><br>
If I'd known there were options, I would have never, ever, ever had a baby in the hospital...and maybe I wouldn't have all the issues I have, and maybe I wouldn't have my son's ashes on my bookshelf. But, the only part of that anyone would ever see in the records is that my homebirth ended in a dead baby.
 

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<div>Originally Posted by <strong>bailefeliz</strong> <a href="/community/forum/post/15585888"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a></div>
<div style="font-style:italic;">I believe that mandatory data collection is critical to provide true data on outcomes---Critical for true informed consent, for scrutiny of standards of practice, to be able to effectively evaluate safety---Ultimately to promote home birth if outcomes reflect positively as in the Dutch and BC studies.<br><br>
If we all believe in safety of home birth, and safety of US OoH birth practice, there should be no hesitation to establish mandatory data collection of all OoH managed pregnancies and births. That is simply putting the same expectation of accountability and transparency on Ooh birth as exists in hospital birth. I would view any hesitancy in data collection as troubling. Any professional working with families in so vulnerable a window as birth should want data to be able to provide best and safest care to clients.<br><br>
And yes, yes, I believe the same for hospitals. It is clear to me that transparency IS evolving hospital practice, and that is a good thing. (ie--NIH VBAC consensus statement, in-hospital water birth, telemetry monitoring to facilitate mobility and unmedicated births with high risk conditions, etc.)</div>
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I've seen no evidence that transparency is evolving in hospitals (and I'm in BC, fwiw).<br><br>
I'm not all that concerned about data collection, although it's really not as relevant as we'd like to think, imo. I do have concerns about the idea that "lay" midwives shouldn't maintain high risk conditions. That decision (who provides care to a "high risk" mom-to-be) shouldn't be the decision of any kind of regulatory body. I already ended up with one unnecessary surgery, because the local midwives weren't "allowed" to take my case. That disgusts me, personally and philosophically, and it disgusts me that people promote that, in the name of protecting women and babies.
 

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Storm Bride, I can totally relate to what you are saying. I have no desire for regulations to decide where I CAN birth. It's already gone too far! I was a birth choice ignorant young woman, and have a terrible story to tell in regards to my first birth..then I continued down that path. I ended up with a c-section for #3, (transverse lie) and a forced repeat for #4...when I sought out options, the hospitals were so limited. Just three years later I did have a VBA2C in a hospital-but it was hospital monitored and I had to be induced or schedule a section when I went to 41 weeks.<br><br>
I had sought out MW care, but the recent licensure requirements in my state for MW's (that most rave about) meant, as a mom with 2 prior sections, they couldn't legally take me.<br><br>
Now I have a MW for a homebirth, that is putting herself on the line for ME. She knows after 2 vaginal births, and then 2 c-sections (1 maybe needed, 1 definitely not) and a subsequent quick and easy VBA2C, I can have a vaginal birth like the next un-cut woman...but seriously, it's her on the line for me..where have those regulations gotten us here in my state? I would argue my risk is higher for a repeat serious intrauterine infection from a repeat section than it is for rupture-something the stats support, yet is considered highly dangerous apparently by the licensing body.<br><br>
No thanks.
 

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Studies can be flawed and biased.<br><br>
I have found the Center for Disease Control's WONDER database immensely helpful in finding out data for myself. This is link to the Linked Birth/Infant Death Records in the United States.<br><br><a href="http://wonder.cdc.gov/lbd.html" target="_blank">http://wonder.cdc.gov/lbd.html</a><br><br>
Here is the data I discovered for the 2003-2005 data set:<br>
(Number of Infant deaths grouped by Birth Attendant and Birthplace)<br><br><b>Certified Nurse Midwife:</b><br>
In Hospital= 158/802,574 rate of 0.20 per 1,000 live births<br>
Not in Hospital= 16/28,030 rate suppressed<br><br><b>Doctor of Medicine (MD):</b><br>
In Hospital= 3,209/8,939,831 rate of 0.36 per 1,000 live births<br>
Not in Hospital= 16/7,252 (includes a delivery by a parent) rate suppressed<br><br><b>Other Midwife:</b><br>
Not in Hospital= 35/38,483 rate of 0.91 per 1,000 live births<br><br><b>Other</b> (this would include UCs and people who murder their neonates, but all categories have some cases of murder or neglect).<br>
Not in Hospital= 58/20,814 rate of 2.79 per 1,000 live births<br><br>
Groupings: I selected all characteristics of mother, only babies with a gestation of 37+weeks, 2500+ grams, from under 1 hour to 6 days old, all causes of death.<br><br>
This, to me, is scary. If this is true, then midwives who practice out of the hospital really do have triple the neonatal death rate, here in the US. No studies from the 70s, just facts from a few years ago.
 

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so your calculations there put CNM births out of hospital at .57 deaths per 1000, right?<br><br>
what does "rate suppressed" mean?<br><br><br>
Those numbers would seem to say CNMs are the "safest" kind of midwife to choose, but that hospital is still safer, correct?<br><br>
and what flaws might there be in using a system like this to find data? deaths might not be birth related?
 

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<div>Originally Posted by <strong>bicyclingbethany</strong> <a href="/community/forum/post/15586003"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a></div>
<div style="font-style:italic;">This, to me, is scary. If this is true, then midwives who practice out of the hospital really do have triple the neonatal death rate, here in the US. No studies from the 70s, just facts from a few years ago.</div>
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It's not that scary to me, because I have a pretty good idea of some of the hidden factors involved here. There is a <i>lot</i> going on in the birth world that doesn't show up in the stats.<br><br>
I attempted an HBA3C, and my baby died. That's exactly what the staff at the hospital saw, and that's how my case would show up in the stats. What <i>doesn't</i> show up in the stats is the fact that <i>I</i> refused to transfer, because <i>I</i> was too afraid of the hospital, based on how I'd been treated there in the past. (And, for the record, there were staff at that hospital claiming that I didn't seem upset about my son, based on the fact that I was in shock from grief, and so spaced out from the anesthetic that I didn't even <i>remember</i> being told that he'd died. Caring and compassionate birth professionals there, huh? So nice of them to assume that I just didn't care about my child, because I'd been attempting an HBAmC.)<br><br>
Yes - if I'd had that baby in the hospital, he would have probably been born alive. They would have taken him by c-section before I even went into labour. Since we don't know why he died, I have no idea if he'd have survived for a week, a month, a year, lived out a normal life expectancy, or what. I don't know. I do know that he would have been a "success" for the hospital staff, but counts as a failure of high-risk homebirth.<br><br>
I also know that the only way to have changed that would have been to physically force me into an ambulance. If that's what people want to see, in the name of better maternal health, then that's what they want to see. But, it scares me as much as an increased infant death rate does. The presence/absence or type of attendant, in my case would have made no difference.
 

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oh please women have been having their babies at home since the creation of humans! just b/c the hospital can cut a woman open to "save" a baby doesnt mean the baby will survive afterwards. IMO when its your time its your time i dont think homebirthing has anything to do with that.<br><br>
also type of midwife does matter.
 

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I'm very sad you lost your baby. ):<br><br>
I agree with many folks on here- maternal care here in the US is sorely lacking in many areas. Respect for women, their choices, their bodies, etc all is in desperate need of improvement. If a woman makes a choice to birth at home no matter what, than that is her choice. But her choice affects many other people, not just her.<br><br>
The CDC numbers are flawed- there are probably many births that have been recorded improperly. They do not tell us everything. I agree with this.<br><br>
Because of various experiences, I have less and less faith in lay midwives. I believe there are many competent and capable midwives out there, don't get me wrong. But I believe there are many who are sadly incompetent and under-educated.<br><br>
You can say the mantra of "birth is safe, birth is normal" as much as you want, but it doesn't mean nothing bad will happen. 1 out of 12 women die from pregnancy or childbirth in the developing world. This cannot be entirely blamed on poor nutrition.<br>
Midwives have so much to offer in terms of improving maternal and infant health- better prenatals, better nutritional guidance, less interventions, more breastfeeding support- but there are too many midwives out there who genuinely do not know how to handle obstetric emergencies. Or could handle them if they do. But I am continuing to see midwives who are overly confident in the birth process and do not perform even basic care during labor because of this.<br><br>
Here in Texas a baby died because the midwife wanted to deliver him, even though he was breech and she never had ANY clinical experience with this. Another baby died in utero because the midwife failed to take maternal vital signs and make an accurate judgment based on clear signs of fetal distress.<br><br>
Scary, all around. I am afraid to birth anywhere, quite frankly.
 

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<div>Originally Posted by <strong>MyFillingQuiver</strong> <a href="/community/forum/post/15585892"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a></div>
<div style="font-style:italic;"><img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/thumb.gif" style="border:0px solid;" title="thumbs up"> Exactly.<br><br>
I'm not a MW or birth professional, but have dealt with over-zealous MD's, and suffered permanent injury from misdiagnosis during pregnancy..I understand what limited choices for birth can mean.<br><br>
Legislation and regulation, IMHO, <i>rarely solves any issue</i> without creating skyrocketing costs and complications on other levels. Even midwives who are not licensed or "regulated", place a huge value on health and welfare of mom and baby...of course, in any industry-including medical or MW, you have diabolically careless people..those people should be dealt with within the law, but requiring the hoop-jumping of over-regulation for MW's, leads to some of the same flaws we have faced in the Obstetrical community!<br><br>
So many quality MW's, with years of healthy, safe, educated births have been pushed out by regulations and bans on their practices.<br><br>
This is one where it combines being an educated consumer/client, and understanding that sometimes tragedy happens in good circumstances, is a balance we all who choose to birth in any place must face. (I have the utmost respect and humility for any of you who have experienced birth/neonatal loss-I certainly don't claim to know what that pain is, so I didn't want to sound cavalier about that aspect)</div>
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here is the thing- <i>without</i> accurate and reliable studies one cannot be an educated consumer. i feel very duped after losing my daughter, due to an ill-trained CPM. and i felt a second devastation when i took it to the "regulating board" who merely slapped her on the hand, despite finding her negligent.
 

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<div>Originally Posted by <strong>anielasmommy09</strong> <a href="/community/forum/post/15586216"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a></div>
<div style="font-style:italic;">oh please women have been having their babies at home since the creation of humans! just b/c the hospital can cut a woman open to "save" a baby doesnt mean the baby will survive afterwards. IMO when its your time its your time i dont think homebirthing has anything to do with that.<br><br>
also type of midwife does matter.</div>
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You know, I just took a 15-minute break to consider whether it was my responsibility to answer this post or not.<br><br>
And I guess I kind of think that as that 1:10,000 parent, it kind of is. I realize this is a statistical discussion. But there are still people behind the stats.<br><br>
So - in my case, everyone knew at a certain point that a c-section would save my daughter's life. However, one wasn't available right then. During the four days that she survived I held her as she had seizures, gazed into her reflex-less eyes, held her for 8 hours as she fought to take every breath slower and slower, washed her body after she died, dressed her for her funeral, and buried her.<br><br>
I write all that out because your statement that "when it's time it's time" is very easy to say when it's not your baby. My daughter was -- officially, by autopsy -- a strong and healthy baby until she was deprived of oxygen.<br><br>
This was a very natural process. So is CP, in that situation.<br><br>
Does that mean I think every birth should take place in a hospital? No, not at all.<br><br>
But I do think that people need to understand what risk assessment and good decision making mean in labour. It does not serve the homebirth community to ignore risk and throw up hands and say "what will be will be." At the individual level of course parents are free to choose that. But to put air quotes around "save" is a little over the top.
 

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<div>Originally Posted by <strong>bicyclingbethany</strong> <a href="/community/forum/post/15586258"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a></div>
<div style="font-style:italic;">I'm very sad you lost your baby. ):<br><br>
I agree with many folks on here- maternal care here in the US is sorely lacking in many areas. Respect for women, their choices, their bodies, etc all is in desperate need of improvement. If a woman makes a choice to birth at home no matter what, than that is her choice. But her choice affects many other people, not just her.<br><br>
The CDC numbers are flawed- there are probably many births that have been recorded improperly. They do not tell us everything. I agree with this.<br><br>
Because of various experiences, I have less and less faith in lay midwives. I believe there are many competent and capable midwives out there, don't get me wrong. But I believe there are many who are sadly incompetent and under-educated.<br><br>
You can say the mantra of "birth is safe, birth is normal" as much as you want, but it doesn't mean nothing bad will happen. 1 out of 12 women die from pregnancy or childbirth in the developing world. This cannot be entirely blamed on poor nutrition.<br>
Midwives have so much to offer in terms of improving maternal and infant health- better prenatals, better nutritional guidance, less interventions, more breastfeeding support- but there are too many midwives out there who genuinely do not know how to handle obstetric emergencies. Or could handle them if they do. But I am continuing to see midwives who are overly confident in the birth process and do not perform even basic care during labor because of this.<br><br>
Here in Texas a baby died because the midwife wanted to deliver him, even though he was breech and she never had ANY clinical experience with this. Another baby died in utero because the midwife failed to take maternal vital signs and make an accurate judgment based on clear signs of fetal distress.<br><br>
Scary, all around. I am afraid to birth anywhere, quite frankly.</div>
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<img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/thumb.gif" style="border:0px solid;" title="thumbs up"> well said
 
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