Mothering Forum banner
81 - 90 of 90 Posts

·
Registered
Joined
·
857 Posts
<div style="margin:20px;margin-top:5px;">
<div class="smallfont" style="margin-bottom:2px;">Quote:</div>
<table border="0" cellpadding="6" cellspacing="0" width="99%"><tr><td class="alt2" style="border:1px inset;">
<div>Originally Posted by <strong>Twinklefae</strong> <a href="/community/forum/post/15594862"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a></div>
<div style="font-style:italic;">No, that makes perfect sense - MD's out of hospital would mostly be unplanned, emergency type births, not excluding high risk mothers and without any equipment to help a lot of the time. Hurricanes, planes, black outs, etc.</div>
</td>
</tr></table></div>
There are homebirthing MDs who do it on purpose. I had one for DD1's birth.<br>
I've known of 6 or so homebirthing MDs(counting my state and the one next to me) and there are MDs who work in birth centers, also. Unfortunately, it's hard to tell what's going on with those numbers without more specifics.<br><br><div style="margin:20px;margin-top:5px;">
<div class="smallfont" style="margin-bottom:2px;">Quote:</div>
<table border="0" cellpadding="6" cellspacing="0" width="99%"><tr><td class="alt2" style="border:1px inset;">
<div>Originally Posted by <strong>bicyclingbethany</strong> <a href="/community/forum/post/15595010"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a></div>
<div style="font-style:italic;">Laughingfox-<br>
What search criteria did you use?</div>
</td>
</tr></table></div>
I looked at "Linked Birth / Infant Death Records for 2003-2005 with ICD 10 codes", then chose "Birthplace" from "Group Results By", and "Medical Attendant" in the first line that said "Or".<br>
I left the other criteria set at "None" under the first part for grouping results, and I left everything else in its default "All" setting to show all results at once.<br><br><div style="margin:20px;margin-top:5px;">
<div class="smallfont" style="margin-bottom:2px;">Quote:</div>
<table border="0" cellpadding="6" cellspacing="0" width="99%"><tr><td class="alt2" style="border:1px inset;">
<div>Originally Posted by <strong>liz-hippymom</strong> <a href="/community/forum/post/15595022"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a></div>
<div style="font-style:italic;">those rates don't shock anyone else?<br>
Lay midwives have a much higher rate of death than CNMs in or out of the hospital. of course obs have the highest rate they are the ones with all the high risk patients, all the preterm babies, all the no prenatal care-show up to deliver mamas. but obviously- from these numbers- lay midwives are NOT as safe as they could be-<br>
its the difference of getting a masters degree (cnms) or doing a modular based training and observing 100 births (texas standards).</div>
</td>
</tr></table></div>
There are no records on the CDC website for CPMs specifically (which are not the same as "lay" midwives, since they are licensed). I'd like to see how/if the numbers would change if that bit of data was collected.<br>
Anyone can check the "other midwife" box on a birth certificate in my state (and others as well, I imagine), so accurate numbers are not gathered for CPMs.
 

·
Registered
Joined
·
2,812 Posts
<div style="margin:20px;margin-top:5px;">
<div class="smallfont" style="margin-bottom:2px;">Quote:</div>
<table border="0" cellpadding="6" cellspacing="0" width="99%"><tr><td class="alt2" style="border:1px inset;">
<div>Originally Posted by <strong>GuildJenn</strong> <a href="/community/forum/post/15594695"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a></div>
<div style="font-style:italic;"><br>
I don't know. I am not impressed by the meta-analysis, but the homebirth community's immediate dismissal doesn't make me any more comfortable about evidence-based medicine on either side.</div>
</td>
</tr></table></div>
I haven't seen anybody immediately dismiss it. Perhaps I am missing something? I have seen midwives discussing it amongst themselves on facebook or in forums or people discussing it here as well and trying to get a full picture of what was included for data and trying to understand it.
 

·
Registered
Joined
·
8,512 Posts
<div style="margin:20px;margin-top:5px;">
<div class="smallfont" style="margin-bottom:2px;">Quote:</div>
<table border="0" cellpadding="6" cellspacing="0" width="99%"><tr><td class="alt2" style="border:1px inset;">
<div>Originally Posted by <strong>laughingfox</strong> <a href="/community/forum/post/15594825"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a></div>
<div style="font-style:italic;">"Other Midwifes" out of hospital: 3.84 per thousand</div>
</td>
</tr></table></div>
Do these rates control for the type and training of "other midwife?" I also wonder if unplanned and unassisted births get lumped into that number. Please, I'm not dismissing the data. Just seeking clarification.
 

·
Registered
Joined
·
857 Posts
<div style="margin:20px;margin-top:5px;">
<div class="smallfont" style="margin-bottom:2px;">Quote:</div>
<table border="0" cellpadding="6" cellspacing="0" width="99%"><tr><td class="alt2" style="border:1px inset;">
<div>Originally Posted by <strong>Turquesa</strong> <a href="/community/forum/post/15595278"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a></div>
<div style="font-style:italic;">Do these rates control for the type and training of "other midwife?" I also wonder if unplanned and unassisted births get lumped into that number. Please, I'm not dismissing the data. Just seeking clarification.</div>
</td>
</tr></table></div>
To the best of my knowledge, there are no controls in place for "other midwife"; I believe this info is largely gathered from birth certificates. With a limited number of boxes to check, it's probably somewhat open to interpretation when it's self-reported by folks who don't really "fit" into any of the boxes. I'd bet a lot of stuff gets lumped in with "other midwife".<br><br>
I was just posting those numbers because the in hospital/out of hospital numbers for relevant scenarios showed a different picture than this study/analysis did.<br>
Sorry for the tangent, OP!
 

·
Registered
Joined
·
5,492 Posts
so I have been involved or attending births since the 80's and communicate with midwives all the time not just where I currently live but across the country- we have talked about deaths and complications and discuss what has happened in their region- so saying that mws have 3x the death rate did not make any sense to me and I knew that there had to be some other manipulated info going on sounded similar to the Pang study which was gleaned from Wash. State birth cert info so every birth that was documented as out side the hospital was atributed to midwife attendance- also very recently I had discussed transfer rates and death rates in 2 states with midwives who had looked at/compiled the raw data that their health departments had gathered- and they said the mortality rates were lower than the state rates-- I was looking specifically for any info related to vitamin K- which is what prompted my inquiry- so I have alot of reasons to doubt the info<br><br><br><br>
looked at the references- they used the Pang study as their meta analysis data from the US---
 

·
Premium Member
Joined
·
1,822 Posts
<div style="margin:20px;margin-top:5px;">
<div class="smallfont" style="margin-bottom:2px;">Quote:</div>
<table border="0" cellpadding="6" cellspacing="0" width="99%"><tr><td class="alt2" style="border:1px inset;">
<div>Originally Posted by <strong>mwherbs</strong> <a href="/community/forum/post/15595640"><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 every birth that was documented as out side the hospital was atributed to midwife attendance</div>
</td>
</tr></table></div>
And this I think we can all probably agree is a huge problem.<br><br>
I'm a UC supporter as a birth choice. That being said I think even a planned UC where something goes wrong would be safer with a trained attendant there most of the time. Usually nothing goes wrong, and when it does it can usually be handled fairly easily, but there are definitely times where having trained eyes and hands can make all the difference in safety.<br><br>
And that is just planned UC. The difference in safety between unplanned UC and just about anything else is going to be huge. It's true that you get the babies that just come fast for well nourished, healthy Moms where babe is in a great position and it just happens. Even still who knows who is around to help that could do damage by their lack of knowledge (pulling on cord comes to mind immediately). It's also true you get the Moms who for whatever reason safety wise shouldn't plan a UC, or possibly even an out of hospital birth and they still sometimes for a myriad of reasons deliver outside of the hospital too.<br><br>
That's not a true representation of having a midwife there to support and assist.
 

·
Registered
Joined
·
207 Posts
The Big Push just emailed this out:<br><br>
International Expert Calls Study Deeply Flawed<br>
and Politically Motivated<br><br><br>
FOR IMMEDIATE RELEASE<br><br>
WASHINGTON, D.C. (July 7, 2010) – As New York and Massachusetts moved to pass pro-midwife bills in the final weeks of their legislative sessions, the American Journal of Obstetrics and Gynecology fast-tracked publicity surrounding the results of an anti-home birth study that is not scheduled for publication until September. Described as unscientific and politically motivated, the study draws conclusions about home birth that stand in direct contradiction to the large body of research establishing the safety of home birth for low-risk women whose babies are delivered by professional midwives.<br><br>
“Many of the studies from which the author’s conclusions are drawn are poor quality, out-of-date, and based on discredited methodology. Garbage in, garbage out.” said Michael C. Klein, MD, a University of British Columbia emeritus professor and senior scientist at The Child and Family Research Institute. “The conclusion that this study somehow confirms an increased risk for home birth is pure fiction. In fact, the study is so deeply flawed that the only real conclusion to draw is that the motive behind its publication has more to do with politics than with science.”<br><br>
Advocates working to expand access to out-of-hospital maternity care questioned the timing of AJOG’s public relations efforts on behalf of a study that won’t be published until next fall.<br><br>
“Given the fact that New York just passed a bill providing autonomous practice for all licensed midwives working in all settings, while Massachusetts is poised to do the same, the timing of this study could not be better for the physician groups that have been fighting so hard to defeat pro-midwife bills there and in other states,” said Susan M. Jenkins, Legal Counsel for The Big Push for Midwives Campaign. “Clearly the intent is to fuel fear-based myths about the safety of professional midwifery care in out-of-hospital settings. Their ultimate goal is obviously to defeat legislation that would both increase access to out-of-hospital maternity care for women and their families and increase competition for obstetricians.”<br><br>
The United States recognizes two categories of midwives: Certified Nurse-Midwives, who are trained to practice in hospital settings and who also provide primary and well-woman care, and Certified Professional Midwives, who undergo specialized clinical training to provide maternity care in out-of-hospital settings. Research consistently shows that midwife outcomes in all settings are equivalent to those of physicians, but with far fewer costly and preventable interventions, including a significant reduction in pre-term and low birth weight births, and as much as a five-fold decrease in cesarean surgeries.<br><br>
The Big Push for Midwives Campaign represents thousands of grassroots advocates in the United States who support expanding access to Certified Professional Midwives and out-of-hospital maternity care. The mission of The Big Push for Midwives includes educating state and national policymakers about the reduced costs and improved outcomes associated with births managed by CPMs in private homes and freestanding birth centers. Media inquiries: Katherine Prown (414) 550-8025, <a href="mailto:[email protected]">[email protected]</a>
 

·
Registered
Joined
·
2,063 Posts
<div style="margin:20px;margin-top:5px;">
<div class="smallfont" style="margin-bottom:2px;">Quote:</div>
<table border="0" cellpadding="6" cellspacing="0" width="99%"><tr><td class="alt2" style="border:1px inset;">
<div>Originally Posted by <strong>stella.rose</strong> <a href="/community/forum/post/15597910"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a></div>
<div style="font-style:italic;">The Big Push just emailed this out:<br><br>
International Expert Calls Study Deeply Flawed<br>
and Politically Motivated<br><br>
FOR IMMEDIATE RELEASE</div>
</td>
</tr></table></div>
Thanks for posting!<br><br>
I wanted to share on Facebook, but the release is a PDF!<br><br><a href="http://www.thebigpushformidwives.org/_ccLib/downloads/7-7-2010_PushNews_RELEASE_OB-GYN_Journal_Fast_Tracks_Publicity_on_Deeply_Flawed_Study.pdf" target="_blank">http://www.thebigpushformidwives.org...awed_Study.pdf</a><br><br>
They really should have an HTML version for sharing.
 

·
Registered
Joined
·
115 Posts
See if either of these work, and thanks for spreading the word!<br><br><a href="http://tinyurl.com/256gbwk" target="_blank">http://tinyurl.com/256gbwk</a><br><a href="http://tinyurl.com/mx5zp5" target="_blank">http://tinyurl.com/mx5zp5</a><br><br>
The full headline is:<br><br>
OB/GYN Journal Fast Tracks Anti-Home Birth Study in Advance of Pro-Midwife Legislation<br>
International Expert Calls Study Deeply Flawed and Politically Motivated<br><br>
Katie
 

·
Registered
Joined
·
22 Posts
<div style="margin:20px;margin-top:5px;">
<div class="smallfont" style="margin-bottom:2px;">Quote:</div>
<table border="0" cellpadding="6" cellspacing="0" width="99%"><tr><td class="alt2" style="border:1px inset;">
<div>Originally Posted by <strong>Turquesa</strong> <a href="/community/forum/post/15591023"><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 not sure I understand this sentence. <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/redface.gif" style="border:0px solid;" title="Embarrassment"> So your Pubic Health Division is admitting to inputting flawed data? (</div>
</td>
</tr></table></div>
Sorry I am just now responding, Turquesa. Was internet free for a bit (blissful--I highly recommend it <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/smile.gif" style="border:0px solid;" title="smile">)<br><br>
But, yes, the Public Health Division issued a statement of apology for erroneous numbers due to data input problems after an investigation was requested because of published numbers putting LDM fetal death rate at 4-10 X higher than all other providers. All data was thrown out as a result.<br><br>
So we still do not have true data. We DO know number of fetal deaths, and we know # of TERM fetal deaths (48 total for my State for 2006---for an overall rate of 1:1000). This, of course, includes all cases of women presenting to their provider with an already demised neonate, and/or extremely sick mamas and babies. Much more concerning in my mind are cases of term <b>intrapartum</b> fetal death of otherwise healthy babies. It is so rare that it is hardly mentioned in the literature, that I can find. (Please share sources if you have any!) The only study I found puts rate of term intrapartum perinatal death overall at .3:1000--very rare. I am concerned that this rate is higher in OoH birth management in the US. And I believe that more conservative risk screening would diminish higher rates of term loss, as demonstrated in the BC and Dutch studies.<br><br>
I continue to think mandatory data collection is the only way for us to discover true outcomes, critical for true informed consent. In my mind, nformed consent is a fallacy without provider specific regional data.
 
81 - 90 of 90 Posts
Top