Re: Planned home births associated with tripling of neonatal mortality rate vs. planned hospital births

[Guest guest]

My own experience 2 wks ago- home birth mom previous C/S, IVF, increase BP. Homebirth midwife talks to my CNM we see at 40 wks do repeat C/S then Hys for placenta acreta, can only imagine what would have happened if she delivered at home, Hmm, Karla Polaschek MD, FACOGSent from my Verizon Wireless BlackBerrySender: nfpprofessionals Date: Thu, 1 Jul 2010 11:55:08 -0700 (PDT)To: NFP<nfpprofessionals >ReplyTo: nfpprofessionals Subject: Planned home births associated with tripling of neonatal mortality rate vs. planned hospital births Planned home births associated with tripling of neonatal mortality rate vs. planned hospital birthsAccording to new study published in the American Journal of Obstetrics & GynecologyPhiladelphia, PA, July 1, 2010 – About 1 in 200 women in the US delivers her baby at home, with approximately 75% of these low-risk, single-baby births planned in advance as home deliveries. In a study published online today by the American Journal of Obstetrics & Gynecology (AJOG), researchers from Maine Medical Center, Portland, Maine, analyzed the results of multiple studies from around the world. They report that less medical intervention, characteristic of planned home births, is associated with a tripling of the neonatal mortality rate compared to planned hospital deliveries. Planned home births were characterized by a greater proportion of deaths attributed to respiratory distress and failed resuscitation. " Our findings raise the question of a link between the increased neonatal mortality among planned home births and the decreased obstetric intervention in this group, " according to lead investigator ph R. Wax, MD, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Maine Medical Center. " Women choosing home birth, particularly low-risk individuals who had given birth previously, are in large part successful in achieving their goal of delivering with less morbidity and medical intervention than experienced during hospital-based childbirth. Of significant concern, these apparent benefits are associated with a doubling of the neonatal mortality rate overall and a near tripling among infants born without congenital defects (nonanomalous). …These findings echo concerns raised in a recent large US cohort study in which home births experienced significantly more 5-minute Apgar scores < 7 as compared to low-risk term hospitalbirths, suggesting an increased need for resuscitation among home births. Therefore, the personnel, training, and equipment available for neonatal resuscitation represent other possible contributors to the excessive neonatal mortality rate among planned home births. " Investigators conducted a rigorous metaanalysis through which the peer-reviewed medical literature was searched for studies that contained information about home and hospital deliveries, including morbidity and mortality data for both mother and child. They extracted data for a total of 342,056 planned home and 207,551 planned hospital deliveries. The results are striking as women planning home births were of similar and often lower obstetric risk than those planning hospital births.In contrast to neonatal mortality rates, investigators observed that perinatal mortality rates for planned home and hospital births were similar overall, as well as just among nonanomalous offspring. Mothers in planned home births experienced significantly fewer medical interventions including epidural analgesia, electronic fetal heart rate monitoring, episiotomy, and operative vaginal and cesarean deliveries. Likewise, women intending home deliveries had fewer infections, perineal and vaginal lacerations, hemorrhages, and retained placentas. Data also showed that planned home births are characterized by less frequent premature and low birthweight infants.AJOG Editors-in- Chief J. Garite, MD, and Moon H. Kim, MD, commented that " The report by Wax et al supports the safety of planned home birth for the mother, but raises serious concerns about increased risks of home birth for the newborn infant. This topic deserves more attention from public health officials at state and national levels. " ###The article is " Maternal and newborn outcomes in planned home birth vs planned hospital births: a metaanalysis " by ph R. Wax, MD; F. Lee Lucas, PhD; anne Lamont, MLS; G. Pinette, MD; Angelina Cartin; and Jacquelyn Blackstone, DO. It will appear in the American Journal of Obstetrics & Gynecology, Volume 203, Issue 3 (September 2010) published by Elsevier. DOI: 10.1016/j.ajog.2010.05.028----------------------------------------------------------[ Print | E-mail | Share ] [ Close Window ] Bookmark & ShareXSelect from these web-based feed readers:

[Guest guest]

I'm really not sure how this is on topic for this list, but I am suspicious just reading the synopsis.  Sounds like a team intending to find a greater risk of neonatal death combed the literature and found data to support their suppositions.  Retrospective literature studies like these are notoriously inaccurate.  As a mama of six, five planned home births, I could say a lot, lot more, but like I said, I don't believe this is on topic here.  

--Bekah<><http://our-family.family-way.net/appletreewebdesigns.comLearn about Home Birth: morebabiespreferhomebirth.com

Planned home births associated with tripling of neonatal mortality rate vs. planned hospital births

According to new study published in the American Journal of Obstetrics & Gynecology

Philadelphia, PA, July 1, 2010 – About 1 in 200 women in the US delivers her baby at home, with approximately 75% of these low-risk, single-baby births planned in advance as home deliveries. In a study published online today by the American Journal of Obstetrics & Gynecology (AJOG), researchers from Maine Medical Center, Portland, Maine, analyzed the results of multiple studies from around the world. They report that less medical intervention, characteristic of planned home births, is associated with a tripling of the neonatal mortality rate compared to planned hospital deliveries. Planned home births were characterized by a greater proportion of deaths attributed to respiratory distress and failed resuscitation.

" Our findings raise the question of a link between the increased neonatal mortality among planned home births and the decreased obstetric intervention in this group, " according to lead investigator ph R. Wax, MD, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Maine Medical Center. " Women choosing home birth, particularly low-risk individuals who had given birth previously, are in large part successful in achieving their goal of delivering with less morbidity and medical intervention than experienced during hospital-based childbirth. Of significant concern, these apparent benefits are associated with a doubling of the neonatal mortality rate overall and a near tripling among infants born without congenital defects (nonanomalous). …These findings echo concerns raised in a recent large US cohort study in which home births experienced significantly more 5-minute Apgar scores < 7 as compared to low-risk term hospital

 births, suggesting an increased need for resuscitation among home births. Therefore, the personnel, training, and equipment available for neonatal resuscitation represent other possible contributors to the excessive neonatal mortality rate among planned home births. "

Investigators conducted a rigorous metaanalysis through which the peer-reviewed medical literature was searched for studies that contained information about home and hospital deliveries, including morbidity and mortality data for both mother and child. They extracted data for a total of 342,056 planned home and 207,551 planned hospital deliveries. The results are striking as women planning home births were of similar and often lower obstetric risk than those planning hospital births.

In contrast to neonatal mortality rates, investigators observed that perinatal mortality rates for planned home and hospital births were similar overall, as well as just among nonanomalous offspring.

Mothers in planned home births experienced significantly fewer medical interventions including epidural analgesia, electronic fetal heart rate monitoring, episiotomy, and operative vaginal and cesarean deliveries. Likewise, women intending home deliveries had fewer infections, perineal and vaginal lacerations, hemorrhages, and retained placentas. Data also showed that planned home births are characterized by less frequent premature and low birthweight infants.

AJOG Editors-in- Chief J. Garite, MD, and Moon H. Kim, MD, commented that " The report by Wax et al supports the safety of planned home birth for the mother, but raises serious concerns about increased risks of home birth for the newborn infant. This topic deserves more attention from public health officials at state and national levels. "

###

The article is " Maternal and newborn outcomes in planned home birth vs planned hospital births: a metaanalysis " by ph R. Wax, MD; F. Lee Lucas, PhD; anne Lamont, MLS; G. Pinette, MD; Angelina Cartin; and Jacquelyn Blackstone, DO. It will appear in the American Journal of Obstetrics & Gynecology, Volume 203, Issue 3 (September 2010) published by Elsevier. DOI: 10.1016/j.ajog.2010.05.028

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[Guest guest]

The questioin it raises in my mind is why medical systems are not properly prepared to deal with birth in the natural home environment.   We've had five children, all but the dfirst at home and even the first not in a full hospital setting.   In every case we have had good, well qualified midwives and doctors perfectly capable of delaing with any resuscitation requirements - and this within the National Health Service (so freely available to anyone - at least in theory).   THere is also the avilability in case of emergency of a highly equipped obstetric 'flying squad': we didn't need it, but we have friends who did in one case.

However we are well aware that the NHS is not universally providing this level of care, with parts of the country where centralist and hospital-driven systems effectively deprive women of the right to give birth amid their family in a low-stress (and in service provision budget terms, low-cost) home environment.  It's getting a lot better, but there are still areas where the standard route is hospital, and the option for home birth, whilst theoretically present, is seriously underprovided.  It's scarcely surprising that home birth outcomes vary widely within this country according to NHS regions.

There is a linkage here to NFP: women who are used to doignt hings naturally as far as their family planning practice is concerned, and who have developeed the knowledge of how the reproductive system works, are less likely to assume that a standard interventionist approach to birth is right for them, just as they have learnt that a standard interventionist approach to family planning is not right for them.   Interventionist birth practices also tend to reduce the chances of successful breastfeeding, leading to difficulties with use of NFP during the postpartum period.

-- Aldred

I'm really not sure how this is on topic for this list, but I am suspicious just reading the synopsis.  Sounds like a team intending to find a greater risk of neonatal death combed the literature and found data to support their suppositions.  Retrospective literature studies like these are notoriously inaccurate.  As a mama of six, five planned home births, I could say a lot, lot more, but like I said, I don't believe this is on topic here.  

--Bekah<><http://our-family.family-way.net/appletreewebdesigns.com

Learn about Home Birth: morebabiespreferhomebirth.com

Planned home births associated with tripling of neonatal mortality rate vs. planned hospital births

According to new study published in the American Journal of Obstetrics & Gynecology

Philadelphia, PA, July 1, 2010 – About 1 in 200 women in the US delivers her baby at home, with approximately 75% of these low-risk, single-baby births planned in advance as home deliveries. In a study published online today by the American Journal of Obstetrics & Gynecology (AJOG), researchers from Maine Medical Center, Portland, Maine, analyzed the results of multiple studies from around the world. They report that less medical intervention, characteristic of planned home births, is associated with a tripling of the neonatal mortality rate compared to planned hospital deliveries. Planned home births were characterized by a greater proportion of deaths attributed to respiratory distress and failed resuscitation.

" Our findings raise the question of a link between the increased neonatal mortality among planned home births and the decreased obstetric intervention in this group, " according to lead investigator ph R. Wax, MD, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Maine Medical Center. " Women choosing home birth, particularly low-risk individuals who had given birth previously, are in large part successful in achieving their goal of delivering with less morbidity and medical intervention than experienced during hospital-based childbirth. Of significant concern, these apparent benefits are associated with a doubling of the neonatal mortality rate overall and a near tripling among infants born without congenital defects (nonanomalous). …These findings echo concerns raised in a recent large US cohort study in which home births experienced significantly more 5-minute Apgar scores < 7 as compared to low-risk term hospital

 births, suggesting an increased need for resuscitation among home births. Therefore, the personnel, training, and equipment available for neonatal resuscitation represent other possible contributors to the excessive neonatal mortality rate among planned home births. "

Investigators conducted a rigorous metaanalysis through which the peer-reviewed medical literature was searched for studies that contained information about home and hospital deliveries, including morbidity and mortality data for both mother and child. They extracted data for a total of 342,056 planned home and 207,551 planned hospital deliveries. The results are striking as women planning home births were of similar and often lower obstetric risk than those planning hospital births.

In contrast to neonatal mortality rates, investigators observed that perinatal mortality rates for planned home and hospital births were similar overall, as well as just among nonanomalous offspring.

Mothers in planned home births experienced significantly fewer medical interventions including epidural analgesia, electronic fetal heart rate monitoring, episiotomy, and operative vaginal and cesarean deliveries. Likewise, women intending home deliveries had fewer infections, perineal and vaginal lacerations, hemorrhages, and retained placentas. Data also showed that planned home births are characterized by less frequent premature and low birthweight infants.

AJOG Editors-in- Chief J. Garite, MD, and Moon H. Kim, MD, commented that " The report by Wax et al supports the safety of planned home birth for the mother, but raises serious concerns about increased risks of home birth for the newborn infant. This topic deserves more attention from public health officials at state and national levels. "

###

The article is " Maternal and newborn outcomes in planned home birth vs planned hospital births: a metaanalysis " by ph R. Wax, MD; F. Lee Lucas, PhD; anne Lamont, MLS; G. Pinette, MD; Angelina Cartin; and Jacquelyn Blackstone, DO. It will appear in the American Journal of Obstetrics & Gynecology, Volume 203, Issue 3 (September 2010) published by Elsevier. DOI: 10.1016/j.ajog.2010.05.028

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[Guest guest]

Analysis in this study seen as " deeply flawed " .

http://www.theglobeandmail.com/life/health/us-analysis-on-home-birth-risks-seen-as-deeply-flawed/article1624918/

See below - thanks.

Pam Pilch, JD, LCCE

Catholic Nursing Mothers League

Tralee Pearce

From Thursday's Globe and MailPublished on Wednesday, Jun. 30, 2010 6:19PM EDTLast updated on Wednesday, Jun. 30, 2010 7:45PM EDT

A new study by U.S. researchers questions the safety of giving birth at home, suggesting that more babies die during home births than during hospital deliveries. But Canadian researchers, whose data were extracted and used in the study, say that conclusion is deeply flawed.

The meta-analysis of 15 studies, led by ph Wax of the Maine Medical Center’s department of obstetrics and gynecology, found that giving birth at home tripled the risk of neonatal death.

Janssen, an associate professor at the University of British Columbia’s school of population and public health, says that conclusion is “sensationalist” and based on data that are in some cases decades old, on very small samples and in some cases incomplete.

In many cases, she says, women included in the studies may not have planned to give birth at home. They may not have been attended by a properly trained midwife. And much of the data used were retrospectively, gathered using birth records, which may not include enough information.

Dr. Janssen’s most recent research, published last September, found no difference in outcomes between planned hospital births and planned home births. Similar results were found in an Ontario study.

More at the link provided above.

 

Planned home births associated with tripling of neonatal mortality rate vs. planned hospital births

According to new study published in the American Journal of Obstetrics & Gynecology

Philadelphia, PA, July 1, 2010 – About 1 in 200 women in the US delivers her baby at home, with approximately 75% of these low-risk, single-baby births planned in advance as home deliveries. In a study published online today by the American Journal of Obstetrics & Gynecology (AJOG), researchers from Maine Medical Center, Portland, Maine, analyzed the results of multiple studies from around the world. They report that less medical intervention, characteristic of planned home births, is associated with a tripling of the neonatal mortality rate compared to planned hospital deliveries. Planned home births were characterized by a greater proportion of deaths attributed to respiratory distress and failed resuscitation.

" Our findings raise the question of a link between the increased neonatal mortality among planned home births and the decreased obstetric intervention in this group, " according to lead investigator ph R. Wax, MD, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Maine Medical Center. " Women choosing home birth, particularly low-risk individuals who had given birth previously, are in large part successful in achieving their goal of delivering with less morbidity and medical intervention than experienced during hospital-based childbirth. Of significant concern, these apparent benefits are associated with a doubling of the neonatal mortality rate overall and a near tripling among infants born without congenital defects (nonanomalous). …These findings echo concerns raised in a recent large US cohort study in which home births experienced significantly more 5-minute Apgar scores < 7 as compared to low-risk term hospital

births, suggesting an increased need for resuscitation among home births. Therefore, the personnel, training, and equipment available for neonatal resuscitation represent other possible contributors to the excessive neonatal mortality rate among planned home births. "

Investigators conducted a rigorous metaanalysis through which the peer-reviewed medical literature was searched for studies that contained information about home and hospital deliveries, including morbidity and mortality data for both mother and child. They extracted data for a total of 342,056 planned home and 207,551 planned hospital deliveries. The results are striking as women planning home births were of similar and often lower obstetric risk than those planning hospital births.

In contrast to neonatal mortality rates, investigators observed that perinatal mortality rates for planned home and hospital births were similar overall, as well as just among nonanomalous offspring.

Mothers in planned home births experienced significantly fewer medical interventions including epidural analgesia, electronic fetal heart rate monitoring, episiotomy, and operative vaginal and cesarean deliveries. Likewise, women intending home deliveries had fewer infections, perineal and vaginal lacerations, hemorrhages, and retained placentas. Data also showed that planned home births are characterized by less frequent premature and low birthweight infants.

AJOG Editors-in- Chief J. Garite, MD, and Moon H. Kim, MD, commented that " The report by Wax et al supports the safety of planned home birth for the mother, but raises serious concerns about increased risks of home birth for the newborn infant. This topic deserves more attention from public health officials at state and national levels. "

###

The article is " Maternal and newborn outcomes in planned home birth vs planned hospital births: a metaanalysis " by ph R. Wax, MD; F. Lee Lucas, PhD; anne Lamont, MLS; G. Pinette, MD; Angelina Cartin; and Jacquelyn Blackstone, DO. It will appear in the American Journal of Obstetrics & Gynecology, Volume 203, Issue 3 (September 2010) published by Elsevier. DOI: 10.1016/j.ajog.2010.05.028

----------------------------------------------------------

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[Guest guest]

I know many of you will remain unconvinced, but you should see, as my OBG colleagues and I do daily, just exactly what can and does go wrong in so called "low risk" births. Is a baby's life worth trying to prove the "experts" wrong?

W. , M.D.,FACOG

Re: Planned home births associated with tripling of neonatal mortality rate vs. planned hospital births

Analysis in this study seen as "deeply flawed".

http://www.theglobeandmail.com/life/health/us-analysis-on-home-birth-risks-seen-as-deeply-flawed/article1624918/

See below - thanks.

Pam Pilch, JD, LCCE

Catholic Nursing Mothers League

Tralee Pearce

From Thursday's Globe and MailPublished on Wednesday, Jun. 30, 2010 6:19PM EDTLast updated on Wednesday, Jun. 30, 2010 7:45PM EDT

A new study by U.S. researchers questions the safety of giving birth at home, suggesting that more babies die during home births than during hospital deliveries. But Canadian researchers, whose data were extracted and used in the study, say that conclusion is deeply flawed.

The meta-analysis of 15 studies, led by ph Wax of the Maine Medical Center’s department of obstetrics and gynecology, found that giving birth at home tripled the risk of neonatal death.

Janssen, an associate professor at the University of British Columbia’s school of population and public health, says that conclusion is “sensationalist†and based on data that are in some cases decades old, on very small samples and in some cases incomplete.

In many cases, she says, women included in the studies may not have planned to give birth at home. They may not have been attended by a properly trained midwife. And much of the data used were retrospectively, gathered using birth records, which may not include enough information.

Dr. Janssen’s most recent research, published last September, found no difference in outcomes between planned hospital births and planned home births. Similar results were found in an Ontario study.

More at the link provided above.

On Thu, Jul 1, 2010 at 2:55 PM, lau gra <wfb_2> wrote:

Planned home births associated with tripling of neonatal mortality rate vs. planned hospital births

According to new study published in the American Journal of Obstetrics & Gynecology

Philadelphia, PA, July 1, 2010 – About 1 in 200 women in the US delivers her baby at home, with approximately 75% of these low-risk, single-baby births planned in advance as home deliveries. In a study published online today by the American Journal of Obstetrics & Gynecology (AJOG), researchers from Maine Medical Center, Portland, Maine, analyzed the results of multiple studies from around the world. They report that less medical intervention, characteristic of planned home births, is associated with a tripling of the neonatal mortality rate compared to planned hospital deliveries. Planned home births were characterized by a greater proportion of deaths attributed to respiratory distress and failed resuscitation.

"Our findings raise the question of a link between the increased neonatal mortality among planned home births and the decreased obstetric intervention in this group," according to lead investigator ph R. Wax, MD, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Maine Medical Center. "Women choosing home birth, particularly low-risk individuals who had given birth previously, are in large part successful in achieving their goal of delivering with less morbidity and medical intervention than experienced during hospital-based childbirth. Of significant concern, these apparent benefits are associated with a doubling of the neonatal mortality rate overall and a near tripling among infants born without congenital defects (nonanomalous). …These findings echo concerns raised in a recent large US cohort study in which home births experienced significantly more 5-minute Apgar scores < 7 as compared to low-risk term hospital

births, suggesting an increased need for resuscitation among home births. Therefore, the personnel, training, and equipment available for neonatal resuscitation represent other possible contributors to the excessive neonatal mortality rate among planned home births."

Investigators conducted a rigorous metaanalysis through which the peer-reviewed medical literature was searched for studies that contained information about home and hospital deliveries, including morbidity and mortality data for both mother and child. They extracted data for a total of 342,056 planned home and 207,551 planned hospital deliveries. The results are striking as women planning home births were of similar and often lower obstetric risk than those planning hospital births.

In contrast to neonatal mortality rates, investigators observed that perinatal mortality rates for planned home and hospital births were similar overall, as well as just among nonanomalous offspring.

Mothers in planned home births experienced significantly fewer medical interventions including epidural analgesia, electronic fetal heart rate monitoring, episiotomy, and operative vaginal and cesarean deliveries. Likewise, women intending home deliveries had fewer infections, perineal and vaginal lacerations, hemorrhages, and retained placentas. Data also showed that planned home births are characterized by less frequent premature and low birthweight infants.

AJOG Editors-in- Chief J. Garite, MD, and Moon H. Kim, MD, commented that "The report by Wax et al supports the safety of planned home birth for the mother, but raises serious concerns about increased risks of home birth for the newborn infant. This topic deserves more attention from public health officials at state and national levels."

###

The article is "Maternal and newborn outcomes in planned home birth vs planned hospital births: a metaanalysis" by ph R. Wax, MD; F. Lee Lucas, PhD; anne Lamont, MLS; G. Pinette, MD; Angelina Cartin; and Jacquelyn Blackstone, DO. It will appear in the American Journal of Obstetrics & Gynecology, Volume 203, Issue 3 (September 2010) published by Elsevier. DOI: 10.1016/j.ajog.2010.05.028

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[Guest guest]

With all due respect, playing the " dead baby " card so flippantly is one of the precise reasons so many women turn away from OB care to midwifery care.  Perhaps you might consider that just as women and their husbands can educate themselves and learn to work within their natural fertility to achieve or avoid pregnancy, despite what the " experts " say about that, they can also educate themselves about their birth options and make a well reasoned, educated choice about where to give birth and with whom.  To suggest that women blithely make such an important and counter-cultural decision is disrespectful.  

--Bekah<><http://our-family.family-way.net/appletreewebdesigns.comLearn about Home Birth: morebabiespreferhomebirth.com

I know many of you will remain unconvinced, but you should see, as my OBG colleagues and I do daily, just exactly what can and does go wrong in so called " low risk "  births. Is a baby's life worth trying to prove the " experts " wrong?

 

W. , M.D.,FACOG

Re: Planned home births associated with tripling of neonatal mortality rate vs. planned hospital births

 

Analysis in this study seen as " deeply flawed " .

http://www.theglobeandmail.com/life/health/us-analysis-on-home-birth-risks-seen-as-deeply-flawed/article1624918/

See below - thanks.

Pam Pilch, JD, LCCE

Catholic Nursing Mothers League

Tralee Pearce

From Thursday's Globe and MailPublished on Wednesday, Jun. 30, 2010 6:19PM EDTLast updated on Wednesday, Jun. 30, 2010 7:45PM EDT

A new study by U.S. researchers questions the safety of giving birth at home, suggesting that more babies die during home births than during hospital deliveries. But Canadian researchers, whose data were extracted and used in the study, say that conclusion is deeply flawed.

The meta-analysis of 15 studies, led by ph Wax of the Maine Medical Center’s department of obstetrics and gynecology, found that giving birth at home tripled the risk of neonatal death.

Janssen, an associate professor at the University of British Columbia’s school of population and public health, says that conclusion is “sensationalist†and based on data that are in some cases decades old, on very small samples and in some cases incomplete.

In many cases, she says, women included in the studies may not have planned to give birth at home. They may not have been attended by a properly trained midwife. And much of the data used were retrospectively, gathered using birth records, which may not include enough information.

Dr. Janssen’s most recent research, published last September, found no difference in outcomes between planned hospital births and planned home births. Similar results were found in an Ontario study.

More at the link provided above.

 

Planned home births associated with tripling of neonatal mortality rate vs. planned hospital births

According to new study published in the American Journal of Obstetrics & Gynecology

Philadelphia, PA, July 1, 2010 – About 1 in 200 women in the US delivers her baby at home, with approximately 75% of these low-risk, single-baby births planned in advance as home deliveries. In a study published online today by the American Journal of Obstetrics & Gynecology (AJOG), researchers from Maine Medical Center, Portland, Maine, analyzed the results of multiple studies from around the world. They report that less medical intervention, characteristic of planned home births, is associated with a tripling of the neonatal mortality rate compared to planned hospital deliveries. Planned home births were characterized by a greater proportion of deaths attributed to respiratory distress and failed resuscitation.

" Our findings raise the question of a link between the increased neonatal mortality among planned home births and the decreased obstetric intervention in this group, " according to lead investigator ph R. Wax, MD, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Maine Medical Center. " Women choosing home birth, particularly low-risk individuals who had given birth previously, are in large part successful in achieving their goal of delivering with less morbidity and medical intervention than experienced during hospital-based childbirth. Of significant concern, these apparent benefits are associated with a doubling of the neonatal mortality rate overall and a near tripling among infants born without congenital defects (nonanomalous). …These findings echo concerns raised in a recent large US cohort study in which home births experienced significantly more 5-minute Apgar scores < 7 as compared to low-risk term hospital

births, suggesting an increased need for resuscitation among home births. Therefore, the personnel, training, and equipment available for neonatal resuscitation represent other possible contributors to the excessive neonatal mortality rate among planned home births. "

Investigators conducted a rigorous metaanalysis through which the peer-reviewed medical literature was searched for studies that contained information about home and hospital deliveries, including morbidity and mortality data for both mother and child. They extracted data for a total of 342,056 planned home and 207,551 planned hospital deliveries. The results are striking as women planning home births were of similar and often lower obstetric risk than those planning hospital births.

In contrast to neonatal mortality rates, investigators observed that perinatal mortality rates for planned home and hospital births were similar overall, as well as just among nonanomalous offspring.

Mothers in planned home births experienced significantly fewer medical interventions including epidural analgesia, electronic fetal heart rate monitoring, episiotomy, and operative vaginal and cesarean deliveries. Likewise, women intending home deliveries had fewer infections, perineal and vaginal lacerations, hemorrhages, and retained placentas. Data also showed that planned home births are characterized by less frequent premature and low birthweight infants.

AJOG Editors-in- Chief J. Garite, MD, and Moon H. Kim, MD, commented that " The report by Wax et al supports the safety of planned home birth for the mother, but raises serious concerns about increased risks of home birth for the newborn infant. This topic deserves more attention from public health officials at state and national levels. "

###

The article is " Maternal and newborn outcomes in planned home birth vs planned hospital births: a metaanalysis " by ph R. Wax, MD; F. Lee Lucas, PhD; anne Lamont, MLS; G. Pinette, MD; Angelina Cartin; and Jacquelyn Blackstone, DO. It will appear in the American Journal of Obstetrics & Gynecology, Volume 203, Issue 3 (September 2010) published by Elsevier. DOI: 10.1016/j.ajog.2010.05.028

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[Guest guest]

Hi Dr. -  my only thought in posting the critique of the new study on home birth safety is that it makes sense if home birthing and home birth midwifery care are being challenged on the basis of evidence, to examine the quality of the evidence being used. 

If, on the other hand, the discussion is about anecdote, and " what I've seen in my practice, " I can share that my first son had to be resuscitated in the hospital due to iatrogenic complications, but my two younger sons who were larger (9 lbs and 10 lbs respectively) were born at home with midwives in labors under 2 hours long and with no complications whatsoever.  My personal experience has been that for my family, home birthing was safer for my babies than hospital care.  There are anecdotes both in support of hospital birth and in support of home birth and arguing on the basis of anecdotal evidence is really susceptible to bias, as you know.  

Critique of the present study has been released both in Canada, and also by the National Childbirth Trust in Great Britain.  On the contrary, a good study that demonstrated the safety of PLANNED home birth with Certified Professional Midwives (non-nurse midwives) in North America was published a few years ago in the British Medical Journal.  It was not accepted for publication in a U.S. journal, it is believed, because of politics and bias, but it was generally judged to be a good quality, prospective study.

It is often pointed out that hospital birth is a relatively recent intervention in the natural process of human birth, and that there has never been a prospective randomized controlled trial showing conclusively the superior safety of hospital birth.  There are risks and benefits involved in the choice of any birth place and care provider, and informed consent in every particular would seem advisable for every woman, regardless of her choice. It seems intuitive to most of us (it certainly did to me for many years)  that the ready availability of an OR and emergency care would confer a safety advantage in birthing, but there are also risks involved in the routine interventions that form a part of hospital care, especially as defensive medicine necessitates the use of interventions more to avoid liability rather than to promote optimal birthing conditions for each individual mother and baby.  

For many years, I have worked simultaneously in natural family planning teaching, natural childbirth teaching and giving breastfeeding support.  I am always surprised how many practitioners in one field are so supportive of the natural process pertaining to their area of interest, while in another field are inclined to see that natural process as inadequate or unsafe or unnecessary.  I have met folks who teach eloquently about the goodness of women's bodies and how fertility is not a disease that needs to be suppressed or controlled by technology, but who are inclined to support the use of quite a bit more technological intervention in the birth process than I would expect, or who believe that breastfeeding is unreliable for child spacing or that it is not that important a function to either mother or baby.  On the other hand, I have met natural childbirth supporters who defend the goodness of women's bodies and argue that birth is normal, natural and healthy, not a disease that needs to be controlled or managed by the use of technology, who are perfectly ready to encourage women to take the Pill or to feed formula.  

I would love to see a holistic approach to the functions of women's bodies - the only works I have ever seen that seem to approach this ideal are the Kippleys' and Helen Wessel's - she is the author of The Joy of Natural Childbirth:  Natural Childbirth and the Christian Family which I recommend to everyone.  She is the only author ( a Protestant Christian) other than the Kippleys whom I have ever seen advocate for natural family planning, natural birthing (including home birth) and ecological breastfeeding. That's not true - Dr. attempted to do so as well in his book, Human Ecology:  A Physician's Advice for Human Life.

I'm pretty sure that those authors who have adopted this holistic approach to the functions of women's bodies have been influenced by Dr. Ratner, who was a proponent of home birth, I believe.  

I know, from working with the midwifery lobby here in Virginia, where we have licensed non-nurse midwives (CPMs), that it is very hard for the medical community to approach the evidence in favor of the safety of home birth objectively, and it is hard for the midwifery community to find a way to respond adequately to the often legitimate questions and concerns physicians may have about their practice.  I can say that, at least in my state, the midwifery community is very committed to evidence-based practice, and that safety and fully informed consent are always paramount concerns for the midwives.  Home birth clients tend to be highly educated.  I remember I got the name of my first home birth midwife from a friend whose OB (pro-life Catholic doctor Shadigian) had used that same midwife for her OWN home birth.

I can understand why some midwifery advocates would see your note about sacrificing babies' lives for the sake of proving the experts wrong as inflammatory.  I understand that you are fully formed in the tenets of your profession and that you have a great concern for the sanctity of human life, and I respect that very much. 

Pam Pilch, JD, LCCECatholic Nursing Mother League

 

I know many of you will remain unconvinced, but you should see, as my OBG colleagues and I do daily, just exactly what can and does go wrong in so called " low risk "  births. Is a baby's life worth trying to prove the " experts " wrong?

 

W. , M.D.,FACOG

Re: Planned home births associated with tripling of neonatal mortality rate vs. planned hospital births

 

Analysis in this study seen as " deeply flawed " .

http://www.theglobeandmail.com/life/health/us-analysis-on-home-birth-risks-seen-as-deeply-flawed/article1624918/

See below - thanks.

Pam Pilch, JD, LCCE

Catholic Nursing Mothers League

Tralee Pearce

From Thursday's Globe and MailPublished on Wednesday, Jun. 30, 2010 6:19PM EDTLast updated on Wednesday, Jun. 30, 2010 7:45PM EDT

A new study by U.S. researchers questions the safety of giving birth at home, suggesting that more babies die during home births than during hospital deliveries. But Canadian researchers, whose data were extracted and used in the study, say that conclusion is deeply flawed.

The meta-analysis of 15 studies, led by ph Wax of the Maine Medical Center’s department of obstetrics and gynecology, found that giving birth at home tripled the risk of neonatal death.

Janssen, an associate professor at the University of British Columbia’s school of population and public health, says that conclusion is “sensationalist” and based on data that are in some cases decades old, on very small samples and in some cases incomplete.

In many cases, she says, women included in the studies may not have planned to give birth at home. They may not have been attended by a properly trained midwife. And much of the data used were retrospectively, gathered using birth records, which may not include enough information.

Dr. Janssen’s most recent research, published last September, found no difference in outcomes between planned hospital births and planned home births. Similar results were found in an Ontario study.

More at the link provided above.

 

Planned home births associated with tripling of neonatal mortality rate vs. planned hospital births

According to new study published in the American Journal of Obstetrics & Gynecology

Philadelphia, PA, July 1, 2010 – About 1 in 200 women in the US delivers her baby at home, with approximately 75% of these low-risk, single-baby births planned in advance as home deliveries. In a study published online today by the American Journal of Obstetrics & Gynecology (AJOG), researchers from Maine Medical Center, Portland, Maine, analyzed the results of multiple studies from around the world. They report that less medical intervention, characteristic of planned home births, is associated with a tripling of the neonatal mortality rate compared to planned hospital deliveries. Planned home births were characterized by a greater proportion of deaths attributed to respiratory distress and failed resuscitation.

" Our findings raise the question of a link between the increased neonatal mortality among planned home births and the decreased obstetric intervention in this group, " according to lead investigator ph R. Wax, MD, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Maine Medical Center. " Women choosing home birth, particularly low-risk individuals who had given birth previously, are in large part successful in achieving their goal of delivering with less morbidity and medical intervention than experienced during hospital-based childbirth. Of significant concern, these apparent benefits are associated with a doubling of the neonatal mortality rate overall and a near tripling among infants born without congenital defects (nonanomalous). …These findings echo concerns raised in a recent large US cohort study in which home births experienced significantly more 5-minute Apgar scores < 7 as compared to low-risk term hospital

births, suggesting an increased need for resuscitation among home births. Therefore, the personnel, training, and equipment available for neonatal resuscitation represent other possible contributors to the excessive neonatal mortality rate among planned home births. "

Investigators conducted a rigorous metaanalysis through which the peer-reviewed medical literature was searched for studies that contained information about home and hospital deliveries, including morbidity and mortality data for both mother and child. They extracted data for a total of 342,056 planned home and 207,551 planned hospital deliveries. The results are striking as women planning home births were of similar and often lower obstetric risk than those planning hospital births.

In contrast to neonatal mortality rates, investigators observed that perinatal mortality rates for planned home and hospital births were similar overall, as well as just among nonanomalous offspring.

Mothers in planned home births experienced significantly fewer medical interventions including epidural analgesia, electronic fetal heart rate monitoring, episiotomy, and operative vaginal and cesarean deliveries. Likewise, women intending home deliveries had fewer infections, perineal and vaginal lacerations, hemorrhages, and retained placentas. Data also showed that planned home births are characterized by less frequent premature and low birthweight infants.

AJOG Editors-in- Chief J. Garite, MD, and Moon H. Kim, MD, commented that " The report by Wax et al supports the safety of planned home birth for the mother, but raises serious concerns about increased risks of home birth for the newborn infant. This topic deserves more attention from public health officials at state and national levels. "

###

The article is " Maternal and newborn outcomes in planned home birth vs planned hospital births: a metaanalysis " by ph R. Wax, MD; F. Lee Lucas, PhD; anne Lamont, MLS; G. Pinette, MD; Angelina Cartin; and Jacquelyn Blackstone, DO. It will appear in the American Journal of Obstetrics & Gynecology, Volume 203, Issue 3 (September 2010) published by Elsevier. DOI: 10.1016/j.ajog.2010.05.028

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[Guest guest]

The study is flawed. Others have provided the resources to look up. I have the utmost respect for my FP and OB/GYN colleagues, and I do work everyday with birth. I have worked in ALL settings, from tertiary care- level 3 hospitals (with NICU's), from level 2 centers (from 32-34 wks), to hospitals that only accept term pregnancies, to freestanding birth centers. I have also attended home births as well. I have no problems functioning in, or seeing the value of, each setting for the population that needs or wants them. I can tell you that so many factors determine safety, optimum-care, evidence-based care, mommy-baby centered care, or medical-legal based care-they are impossible to ennummerate in this forum.. Sometimes there is no standard at all- and that is

IN the hospitals. A factor that the vast majority of physicians seem to forget is that the hospital is the place the complications belong. The INTENT or DESIRE of a woman to have a homebirth does NOT cause a problem with the baby, nor does that same intent or desire for a homebirth cause a problem for the mother. If there is a complication, if there is a suspicion that there might be the possibility of a serious problem, the woman needs to be evaluated and possibly even delivered by a person or place able to take into consideration the evaluation and treatment that issue might need. IE a pre-term baby might need to be born in a facility with a NICU. The fact that the mother might have wanted a home birth did not cause her to go into PTL- yet I have heard the gossip "oh and SHE wanted a homebirth - just think what would

have happened..."My own daughter wanted a homebirth, and ended up with a stat C/S and a baby with problems. The C/S and the problems were not caused by the fact she wanted a home birth. She had an appropriate transfer for a suspected problem during labor, which was later confirmed, and resulted in the C/S. Her baby has problems that were dx'd later as clearly resulting from 1st trimester insults. (dx for this not available during pregnancy). Yet, you can probably imagine how I was treated as her mother, and being a CNM. She was treated horribly. There was no fault, there should not have been any blame. The same scenario is played out many a times. Yes, I have seen bad things in hospital- I've worked in them for over 20 yrs. And yes, things can go bad very fast. Many times however, the complications I have seen are the direct result of interventions that were not needed in the first place, or perhaps elective, and a diagnosis that has

been coined "the failure to wait".The beauty of God I have noticed, is that the vast majority of women end up where they ultimately need to be, in order to have a happy, safe birth. We all think "what if", but the reality is, we have a mighty God, and be it by intuition, or choice, or chance, or the little whispers of our guardian angels, or the Holy Spirit- God does take care of His children. I am not suggesting we not use our brains, and not take note of research, or go blindly down any path. I do know that God does have a plan for every one of us, every one of our mothers, and for the babies. Whatever it is that happens, God is ultimately in control. Sandrock, RNC-OB, CNM, MSNTo: nfpprofessionals Sent: Fri, July 2, 2010 1:16:23 PMSubject: Re: Planned home births associated with tripling of neonatal mortality rate vs. planned hospital births

I know many of you will remain unconvinced, but you should see, as my OBG colleagues and I do daily, just exactly what can and does go wrong in so called "low risk" births. Is a baby's life worth trying to prove the "experts" wrong?

W. , M.D.,FACOG

[Guest guest]

Did not mean to offend. I backed up midwives in Virginia while practicing there for 6 years and was excoriated regularly by hospital risk management as well as my back-up call providers. Certainly home births can be safer than hospital births. And autonomy should be respected. My point is that birth and delivery is a risky process, regardless of where it occurs. My frustration is with people who read every bit of lay literature available and listen to everybody but their obstetrician. We study the literature and manage pregnancies and deliveries daily for years, and yet are accused of trying to "control, bully and interfere." All the while, we are held to the impossible standard of never making a mistake or having a less than perfect outcome. As I say, tongue in cheek, if the baby I deliver today doesn't get into Harvard in 18 years, the parents will likely think I did something wrong!

We have an unfortunate case in the ICU who went into respiratory distress with a peritonsillar abcess at 33 weeks and couldn't be intubated. The baby is fine, but mom may not make it. The obstetrician on call (a drop-in patient, naturally) and the anesthesiologist are traumatized. Do you really think it's arrogance which leads us to believe that hospital births are safer? Or personal (anecdotal) experience and fear of malpractice litigation?

As for publication bias, we NFP-only ob-gyns are only too well aware that it exists.

Re: Planned home births associated with tripling of neonatal mortality rate vs. planned hospital births

Analysis in this study seen as "deeply flawed".

http://www.theglobeandmail.com/life/health/us-analysis-on-home-birth-risks-seen-as-deeply-flawed/article1624918/

See below - thanks.

Pam Pilch, JD, LCCE

Catholic Nursing Mothers League

Tralee Pearce

From Thursday's Globe and MailPublished on Wednesday, Jun. 30, 2010 6:19PM EDTLast updated on Wednesday, Jun. 30, 2010 7:45PM EDT

A new study by U.S. researchers questions the safety of giving birth at home, suggesting that more babies die during home births than during hospital deliveries. But Canadian researchers, whose data were extracted and used in the study, say that conclusion is deeply flawed.

The meta-analysis of 15 studies, led by ph Wax of the Maine Medical Center’s department of obstetrics and gynecology, found that giving birth at home tripled the risk of neonatal death.

Janssen, an associate professor at the University of British Columbia’s school of population and public health, says that conclusion is “sensationalist†and based on data that are in some cases decades old, on very small samples and in some cases incomplete.

In many cases, she says, women included in the studies may not have planned to give birth at home. They may not have been attended by a properly trained midwife. And much of the data used were retrospectively, gathered using birth records, which may not include enough information.

Dr. Janssen’s most recent research, published last September, found no difference in outcomes between planned hospital births and planned home births. Similar results were found in an Ontario study.

More at the link provided above.

On Thu, Jul 1, 2010 at 2:55 PM, lau gra <wfb_2> wrote:

Planned home births associated with tripling of neonatal mortality rate vs. planned hospital births

According to new study published in the American Journal of Obstetrics & Gynecology

Philadelphia, PA, July 1, 2010 – About 1 in 200 women in the US delivers her baby at home, with approximately 75% of these low-risk, single-baby births planned in advance as home deliveries. In a study published online today by the American Journal of Obstetrics & Gynecology (AJOG), researchers from Maine Medical Center, Portland, Maine, analyzed the results of multiple studies from around the world. They report that less medical intervention, characteristic of planned home births, is associated with a tripling of the neonatal mortality rate compared to planned hospital deliveries. Planned home births were characterized by a greater proportion of deaths attributed to respiratory distress and failed resuscitation.

"Our findings raise the question of a link between the increased neonatal mortality among planned home births and the decreased obstetric intervention in this group," according to lead investigator ph R. Wax, MD, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Maine Medical Center. "Women choosing home birth, particularly low-risk individuals who had given birth previously, are in large part successful in achieving their goal of delivering with less morbidity and medical intervention than experienced during hospital-based childbirth. Of significant concern, these apparent benefits are associated with a doubling of the neonatal mortality rate overall and a near tripling among infants born without congenital defects (nonanomalous). …These findings echo concerns raised in a recent large US cohort study in which home births experienced significantly more 5-minute Apgar scores < 7 as compared to low-risk term hospital

births, suggesting an increased need for resuscitation among home births. Therefore, the personnel, training, and equipment available for neonatal resuscitation represent other possible contributors to the excessive neonatal mortality rate among planned home births."

Investigators conducted a rigorous metaanalysis through which the peer-reviewed medical literature was searched for studies that contained information about home and hospital deliveries, including morbidity and mortality data for both mother and child. They extracted data for a total of 342,056 planned home and 207,551 planned hospital deliveries. The results are striking as women planning home births were of similar and often lower obstetric risk than those planning hospital births.

In contrast to neonatal mortality rates, investigators observed that perinatal mortality rates for planned home and hospital births were similar overall, as well as just among nonanomalous offspring.

Mothers in planned home births experienced significantly fewer medical interventions including epidural analgesia, electronic fetal heart rate monitoring, episiotomy, and operative vaginal and cesarean deliveries. Likewise, women intending home deliveries had fewer infections, perineal and vaginal lacerations, hemorrhages, and retained placentas. Data also showed that planned home births are characterized by less frequent premature and low birthweight infants.

AJOG Editors-in- Chief J. Garite, MD, and Moon H. Kim, MD, commented that "The report by Wax et al supports the safety of planned home birth for the mother, but raises serious concerns about increased risks of home birth for the newborn infant. This topic deserves more attention from public health officials at state and national levels."

###

The article is "Maternal and newborn outcomes in planned home birth vs planned hospital births: a metaanalysis" by ph R. Wax, MD; F. Lee Lucas, PhD; anne Lamont, MLS; G. Pinette, MD; Angelina Cartin; and Jacquelyn Blackstone, DO. It will appear in the American Journal of Obstetrics & Gynecology, Volume 203, Issue 3 (September 2010) published by Elsevier. DOI: 10.1016/j.ajog.2010.05.028

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I

[Guest guest]

Thank you for your points. I doubt we'd have much debate if all ob/gyns were like you.

Planned home births associated with tripling of neonatal mortality rate vs. planned hospital births

According to new study published in the American Journal of Obstetrics & Gynecology

Philadelphia, PA, July 1, 2010 – About 1 in 200 women in the US delivers her baby at home, with approximately 75% of these low-risk, single-baby births planned in advance as home deliveries. In a study published online today by the American Journal of Obstetrics & Gynecology (AJOG), researchers from Maine Medical Center, Portland, Maine, analyzed the results of multiple studies from around the world. They report that less medical intervention, characteristic of planned home births, is associated with a tripling of the neonatal mortality rate compared to planned hospital deliveries. Planned home births were characterized by a greater proportion of deaths attributed to respiratory distress and failed resuscitation.

"Our findings raise the question of a link between the increased neonatal mortality among planned home births and the decreased obstetric intervention in this group," according to lead investigator ph R. Wax, MD, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Maine Medical Center. "Women choosing home birth, particularly low-risk individuals who had given birth previously, are in large part successful in achieving their goal of delivering with less morbidity and medical intervention than experienced during hospital-based childbirth. Of significant concern, these apparent benefits are associated with a doubling of the neonatal mortality rate overall and a near tripling among infants born without congenital defects (nonanomalous). …These findings echo concerns raised in a recent large US cohort study in which home births experienced significantly more 5-minute Apgar scores < 7 as compared to low-risk term hospital

births, suggesting an increased need for resuscitation among home births. Therefore, the personnel, training, and equipment available for neonatal resuscitation represent other possible contributors to the excessive neonatal mortality rate among planned home births."

Investigators conducted a rigorous metaanalysis through which the peer-reviewed medical literature was searched for studies that contained information about home and hospital deliveries, including morbidity and mortality data for both mother and child. They extracted data for a total of 342,056 planned home and 207,551 planned hospital deliveries. The results are striking as women planning home births were of similar and often lower obstetric risk than those planning hospital births.

In contrast to neonatal mortality rates, investigators observed that perinatal mortality rates for planned home and hospital births were similar overall, as well as just among nonanomalous offspring.

Mothers in planned home births experienced significantly fewer medical interventions including epidural analgesia, electronic fetal heart rate monitoring, episiotomy, and operative vaginal and cesarean deliveries. Likewise, women intending home deliveries had fewer infections, perineal and vaginal lacerations, hemorrhages, and retained placentas. Data also showed that planned home births are characterized by less frequent premature and low birthweight infants.

AJOG Editors-in- Chief J. Garite, MD, and Moon H. Kim, MD, commented that "The report by Wax et al supports the safety of planned home birth for the mother, but raises serious concerns about increased risks of home birth for the newborn infant. This topic deserves more attention from public health officials at state and national levels."

###

The article is "Maternal and newborn outcomes in planned home birth vs planned hospital births: a metaanalysis" by ph R. Wax, MD; F. Lee Lucas, PhD; anne Lamont, MLS; G. Pinette, MD; Angelina Cartin; and Jacquelyn Blackstone, DO. It will appear in the American Journal of Obstetrics & Gynecology, Volume 203, Issue 3 (September 2010) published by Elsevier. DOI: 10.1016/j.ajog.2010.05.028

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[Guest guest]

Transport is not an answer, it's the problem. Have a problem, I don't want to wait for transport. Yes, there are many problems with the labor and delivery industry- but I am afraid NFP followers often idealize homebirth despite the real dangers. I know, I lived them.My homebirth group paid out the largest settlement (a that time) in our state for pure incompetence- undiagnosed rh factor. On top of all of it they destroyed my birth "experience" by hounding me to sign a waiver against malpractice- I had no idea about the lawsuit.I have had awful hospital and doc experiences too. All anecdotal- when it comes down to it, I want access to a number of professionals if one is incompetent. Thankfully my resident physicians made my delivery- one was actually pro-life and BOTH competent...more than I could say for my

actual docs. In both cases I wanted a female physician- ended up at hospital with male MD I had just met- could it have gotten worse,...yes, my premature daughter could have been in the Homebirth's practice hospital with no NICU.I love Ina Gaskin and Spiritual Midwifery, and wish we could all deliver with peace. love, incense in the back of VW van, but....I think a hospital based birth center is the sanest and safest place.

[Guest guest]

I'm so sorry you had a terrible birth experience associated with home birthing. Home birthing is definitely not for everyone, and for whatever reason, a woman who prefers to give birth in the hospital certainly should do so.  I agree that home birth should not be idealized by NFP-ers or anyone else.  

However, just because home birth is not the option for everyone, it doesn't mean that home birth should not be an option for anyone.  Transport - especially if physicians are supportive, knowledgable and helpful on the hospital end of transport - works very well in most cases.  I say most, knowing that someone will jump in and say, " well, even one case where transport doesn't work well means NO ONE should ever give birth at home. "  We could say the same about hospital birth.  Many thousands of people die in hospitals every year from preventable mistakes - but it never follows that no one should use hospitals - in every situation, we look at risks and benefits.  And it is just not true that in EVERY case, the risks of home birthing outweigh the benefits.   It may not be right for you, and that's great.  But it is right for some women, and having well-trained midwives who can count on seamless transport and physician collaboration when necessary makes it all the safer. 

That is one reason why looking at the evidence, while not " gospel " , can be useful in evaluating whether or not an option should or should not be legally available to individuals who give fully informed consent.  It is by no means perfect, but it is worth knowing, when we are discussing POLICY, and not necessarily what any one individual should or should not choose at any given time, to know whether there is any good evidence for or against a particular practice.  It's not sufficient to choose only to look at evidence that supports one's own preferences.  

This thread started out with a post citing a study that purports to show that home birth is dangerous for babies.  This is one piece of evidence that should be considered.  This particular evidence has been criticized and is not congruent with other evidence and knowing these facts enhances everyone's ability to make an objective determination about the risks and benefits of home birthing.

Beyond the evidence, everyone will certainly consider their own experiences, and the training and experience of many doctors and some mothers, will lead them to believe that hospital birth is the only safe option.  The training and experience of midwives and other mothers, will lead them to conclude that home birth is a good option, and perhaps the safest for them.  

As an advocate of home birthing, I would never assert that every woman should have a home birth or that it is right for everyone.  But it is right for many women, and it is an option that should be supported.  I do not idealize this option in any way - I have made a lot of effort to study and inform myself about as many aspects of the practice as I can, and I am persuaded through the use of my reason and experience, that it CAN be safe for those who CHOOSE it.  I think a blanket assertion that home birthing is always and everywhere unsafe and should never be practiced is just a biased opinion, and I think that reviewing the evidence as a check on our opinions is a useful exercise, even if in the end, we remain unconvinced.  We all have the right to reject evidence and go with our own personal beliefs, opinions and experience.

Pam Pilch, JD, LCCECatholic Nursing Mothers League

 

Transport is not an answer, it's the problem. Have a problem, I don't want to wait for transport.  Yes, there are many problems with the labor and delivery industry- but I am afraid NFP followers often idealize homebirth despite the real dangers. I know, I lived them.

My homebirth group paid out the largest settlement (a that time)  in our state for pure incompetence-  undiagnosed rh factor. On top of all of it they destroyed my birth " experience " by hounding me to sign a waiver against malpractice- I had no idea about the lawsuit.

I have had awful hospital and doc experiences too. All anecdotal- when it comes down to it, I want access to a number of professionals if one is incompetent. Thankfully my resident physicians made my delivery- one was actually pro-life and BOTH competent...more than I could say for my

actual docs. In both cases I wanted a female physician- ended up at hospital with male MD I had just met- could it have gotten worse,...yes, my premature daughter could have been in the Homebirth's practice hospital with no NICU.

I love Ina Gaskin and Spiritual Midwifery, and wish we could all deliver with peace. love, incense in the back of VW van, but....I think a hospital based birth center is the sanest and safest place.

[Guest guest]

If you note, I started out with a home birth practice. It is a HUGE well known practice, one could say they are champions in the area of home birth across the nation, but they failed and failed miserably. They were so awful they added stress to my pregnancy by requesting I sign a waiver re: malpractice at every visit. And they did so because of their sloppy care- yes, hospitals can and do commit acts of malpractice but unlike home birth there are others around, there's a system, there's checking and people on rounds- hopefully being updated on patients.Just a year or two ago baby died under the care of the NYC midwife who was the subject of the home birth documentary. The baby inexplicably died, she had vitals one check and not the next. Would she have died if the mother was monitored with one of those horrible belts? I don't know, but I

know as a mother I would blame myself for the rest of my life for not availing myself of the care that is readily available.Truth be told many nurses, midwives, physician assistants and yes, me, think we can play doctor. I resent often the ego and opinion of physicians, but they are, for the most part, smart and well-trained. This intelligence and skill often causes, anecdotally admittedly, a deficit in empathy. That deficit drove me to consider home birth, but now I know I'd rather have competence and medical excellence over someone who asks about my birth plan.To me it's a no brainer, that a well-equipped birthing suite attached to hospital with specialists, like neonatologists, is always superior to a home. I know I was glad and fortunate to have at my disposal a nicu when my "textbook" pregnancy went bad.And I don't believe it's a matter of taking away ones right to home birth that is resented, but rather the medical opinion

that it is not in the best interest of mother or child.I thank the home birth movement and midwives like Gaskin for pushing and demanding reforms, but their assumption that unequipped home is the best space for birth is disappointing at best and hubris at worst.