Home birth risk study

[MissNomer]

I just saw this on Jezebel and thought you all might be interested.

http://jezebel.com/5869719/study-shows- ... fe-so-what

It's a study in the British Medical Journal looking at the risks associated with home birth. They conclude that there is a significantly greater risk of negative outcomes (ranging from death to injury) for women giving birth the first time if they have a home birth rather than a hospital birth. This doesn't seem to be the case for subsequent births however. I personally don't have a strong feeling one way or the other about home births- I think each woman should make the decision that's best for her (although I think unassisted home birth is just reckless). As a scientist, though, I thought it was interesting to see some actual data about the safety of home birth since a lot of the time we tend to mostly discuss anecdotal evidence (which is interesting too of course).

[TinyDancer87]

Have you seen "The Business of Being Born"? www.thebusinessofbeingborn.com

It's very interesting and informative. Because of it, home births/mid-wifery is my primary option in the future, and the hospital is my last resort.

[Beeks]

Once a woman has had a successful vaginal birth, her risks at her second birth go down no matter where she has the baby, right?

[emmiedahl]

Once a woman has had a successful vaginal birth, her risks at her second birth go down no matter where she has the baby, right?

Yep, that is what I have always heard.

I'm glad the UK is studying this. In the US, most of the studies are crap. A lot of bias on both sides. And most of the research in The Business of Being Born is flawed, very flawed.

[TVR]

I am very pro-homebirth, but I disliked The Business of Being Born. I don't think that it does homebirthers any favours, TBH.

[bubbabearzle]

It makes perfect sense to me that outcomes are worst with first births, because we often don't know how labor is for us until we have been through it (we often don't know if certain problems are more likely). IMHO, fully equipped birthing centers appear to be a really good compromise - and they tend to be close enough to hospitals to allow quicker transport if it becomes necessary.

My opinion of home birth is undeniably colored by my experience giving birth to my first child, because he probably would not be here today had I not already been in the hospital. After 24 hours of hard labor, he started having severe distress and I was rushed into emergency surgery. He was delivered via c-section within 15 minutes and is alive and healthy. If I had tried to have him at home, he might not have made it, and if he had he might have brain damage - and I live just 10-15 minutes from the hospital. The thing is, so many problems are impossible to predict and could go so badly so fast. I never guessed I would have needed an emergency c-section - my grandmother (a non-fundie), who is just as short as I am (4'10") had her 11 kids naturally and my own mother (also 4'11") had all 3 of her kids naturally.

[Sinister Rouge]

Interesting. Conversely, if I had had my son in my local hospital with the OB-GYN, there was a greater than 60% chance that he would have been a c-section, given the position he was in. Now, I'm not completely anti-c-sections, they're great when needed, but I was pretty effing happy to have only had to heal from a 2nd degree tear rather than major abdominal surgery. FWIW.

I loved my midwives, and I realize I'm very lucky that midwifery is fully regulated and integrated in to our health care system. I truly wish more women had access to quality care and informed choice rather than having to resort to quackery and unassisted birthing.

It's not where the baby born that effects the outcome, IMO, it's the skill and compassion of the attendants that matters.

[emmiedahl]

It's not where the baby born that effects the outcome, IMO, it's the skill and compassion of the attendants that matters.

Absolutely, although I would add immediate access to emergency supplies like warmed human blood and such to that. Just from my personal experience, it comes in handy, and when you need it you need it now. But a well-trained midwife can handle a large and diverse number of complications and even perform some of those evil interventions if needed. Doctors do need to be compassionate and keep in mind that they are dealing with real people and, just from my experience, medical schools are currently teaching and reinforcing this idea in a way that did not happen in former generations.

Hospital births tend to have more interventions in part because they have a much, much higher percentage of high risk births than home births have. Premature births tend to happen in hospitals--if you go into labor at 6 months gestation, you will go the hospital even if you planned a home birth originally. Births involving pre-eclampsia and gestational diabetes tend to be funneled out of the home birth scene as well, and those are major risk factors for both interventions and negative outcomes. When a home birth goes bad, it is usually the result of a perfectly normal pregnancy with no risk factors. Hospital births include a lot of inherently risky deliveries and thus will have a higher percentage of negative outcomes.

[FakePigtails]

Doesn't the UK even have a good system for certifying midwives? I imagine the statistics would be worse in the US where that system is a mess. Just look at all the direct entry midwives and people like the midwife that Carri Chmielewski consulted (who is actually listed as a CPM!). She is apparently still practicing midwifery, with a shiny website advertising her services and all :-(

[ladypuglover]

I really don't feel that I have a dog in this as I had no choice but hospital births. I really wanted to be able to have the choice of a home birth but I had to give birth with a level 4 NICU. We knew this with our first baby and we saw the proof of why with all 5 sons. Thankfully I had great doctors that let me have as crunchy/hippy birth as we could and lucked out with short labors that I never had to have a c-sec. I won't go into horror stories of what happened but the outcome each time was a succes. We had a live baby with only mild premature problems and a live mother. At the end of the day that is only what really mattered to me.

[Mommy22alyns]

It makes perfect sense to me that outcomes are worst with first births, because we often don't know how labor is for us until we have been through it (we often don't know if certain problems are more likely). IMHO, fully equipped birthing centers appear to be a really good compromise - and they tend to be close enough to hospitals to allow quicker transport if it becomes necessary.

My opinion of home birth is undeniably colored by my experience giving birth to my first child, because he probably would not be here today had I not already been in the hospital. After 24 hours of hard labor, he started having severe distress and I was rushed into emergency surgery. He was delivered via c-section within 15 minutes and is alive and healthy. If I had tried to have him at home, he might not have made it, and if he had he might have brain damage - and I live just 10-15 minutes from the hospital. The thing is, so many problems are impossible to predict and could go so badly so fast. I never guessed I would have needed an emergency c-section - my grandmother (a non-fundie), who is just as short as I am (4'10") had her 11 kids naturally and my own mother (also 4'11") had all 3 of her kids naturally.

Exactly. I had a perfectly normal, textbook pregnancy and birth with my first. Complete placenta previa, major bleed, near emergency C-section at 32 weeks, 4 weeks of hospital bedrest, and planned (and medically necessary) C-section at 36 weeks with my second. Luckily, she didn't need NICU time, but she did need trained hospital staff. You just never know.

[valsa]

Have you seen "The Business of Being Born"? http://www.thebusinessofbeingborn.com

It's very interesting and informative. Because of it, home births/mid-wifery is my primary option in the future, and the hospital is my last resort.

I don't have a dog is this fight either but The Business of Being Born is like The Silent Scream, except for homebirth instead of abortion. Propaganda claptrap.

[Sola]

Doesn't the UK even have a good system for certifying midwives? I imagine the statistics would be worse in the US where that system is a mess. Just look at all the direct entry midwives and people like the midwife that Carri Chmielewski consulted (who is actually listed as a CPM!). She is apparently still practicing midwifery, with a shiny website advertising her services and all :-(

Yes we do. All midwives here are registered nurses who studied a nursing degree and then went on to study midwifery. You cannot practice as a midwife without doing all that, even in the private sector. You must be registered and to be registered you have to have got the nursing degree with further midwifery study.

[alaeangelorum]

Yes we do. All midwives here are registered nurses who studied a nursing degree and then went on to study midwifery. You cannot practice as a midwife without doing all that, even in the private sector. You must be registered and to be registered you have to have got the nursing degree with further midwifery study.

No... you can train to just be a midwife, there is no need to become a nurse first, but if you are a nurse you can do a shorter course to become a midwife - see here. But they are registered with the Nursing and Midwifery Council.

Also most hospital births in the UK are midwife-led, not doctor-led (as I understand they are in the US??), and there are community midwives in the NHS who are able to do things like home births. I think the best solution to the birthing centre thing is to have a midwife-led unit on the hospital site with clear protocols in place for escalating care and moving patients to a delivery suite where there is more intensive monitoring/right next to the operating theatres if this is needed.

[Daenerys]

Yes we do. All midwives here are registered nurses who studied a nursing degree and then went on to study midwifery. You cannot practice as a midwife without doing all that, even in the private sector. You must be registered and to be registered you have to have got the nursing degree with further midwifery study.

That's not quite right. You actually do a completely seperate degree in Midwifery, but it's a three year course and just as rigorous, though more specialised. No hospital would let you near a mother without the qualification. Here's an example course: http://www.worcester.ac.uk/courses/midw ... -hons.html

[Sola]

That's not quite right. You actually do a completely seperate degree in Midwifery, but it's a three year course and just as rigorous, though more specialised. No hospital would let you near a mother without the qualification. Here's an example course: http://www.worcester.ac.uk/courses/midw ... -hons.html

I stand corrected :)

[treemom]

Doesn't the UK even have a good system for certifying midwives? I imagine the statistics would be worse in the US where that system is a mess. Just look at all the direct entry midwives and people like the midwife that Carri Chmielewski consulted (who is actually listed as a CPM!). She is apparently still practicing midwifery, with a shiny website advertising her services and all :-(

I totally agree.

[ladidah]

I think the best solution to the birthing centre thing is to have a midwife-led unit on the hospital site with clear protocols in place for escalating care and moving patients to a delivery suite where there is more intensive monitoring/right next to the operating theatres if this is needed.

Absolutely.

[kayray]

I don't have a dog is this fight either but The Business of Being Born is like The Silent Scream, except for homebirth instead of abortion. Propaganda claptrap.

I really had no business watching the Business of Being Born since I am not having children, and cannot stand Ricki Lake, but even all that aside, that was exactly my impression of the movie.

I confess I felt a small cheer rising in me when the filmmaker DID have to go to the hospital as her baby was breech, and with risk of cord strangulation/death. The cheer was not obviously at the health risk to the baby, but at the fact all her propaganda meant sh!t when it came down to it. That cheer was crushed when later she said something like she "probably would have been fine at home".

[MissNomer]

I really had no business watching the Business of Being Born since I am not having children, and cannot stand Ricki Lake, but even all that aside, that was exactly my impression of the movie.

I confess I felt a small cheer rising in me when the filmmaker DID have to go to the hospital as her baby was breech, and with risk of cord strangulation/death. The cheer was not obviously at the health risk to the baby, but at the fact all her propaganda meant sh!t when it came down to it. That cheer was crushed when later she said something like she "probably would have been fine at home".

Wow, that sounds pretty bad. I've never actually watched the movie because I've heard so many bad things about it. Does anyone know if there are any better done documentaries on the subject? Or websites with good factual information?

[QuoVadis]

Wow, that sounds pretty bad. I've never actually watched the movie because I've heard so many bad things about it. Does anyone know if there are any better done documentaries on the subject? Or websites with good factual information?

I've found this to be a very informative blog from a medical perspective: http://skepticalob.blogspot.com/ (not breaking, since she wouldn't care). Yes, being an OB/GYN, she is heavily biased in the other direction, but she provides sound analysis of many of the studies that have been done and she provides links to the studies themselves. I've always enjoyed her work. And if you want more factual information, you can go to http://www.ncbi.nlm.nih.gov/pubmed/ and type in something like home birth or home and hospital birth, and read all the studies you want. One I'd recommend is http://www.ncbi.nlm.nih.gov/pubmed/20598284 (Am J Obstet Gynecol 2011; Apr 204(4):e7-13), a meta-analysis of outcomes. Biased? Well, the authors are all doctors....but then, I haven't seen a lot of well-conducted noncertified midwife produced studies to refute it.

[ilovetchotchkes]

I've found this to be a very informative blog from a medical perspective: http://skepticalob.blogspot.com/ (not breaking, since she wouldn't care). Yes, being an OB/GYN, she is heavily biased in the other direction, but she provides sound analysis of many of the studies that have been done and she provides links to the studies themselves. I've always enjoyed her work. And if you want more factual information, you can go to http://www.ncbi.nlm.nih.gov/pubmed/ and type in something like home birth or home and hospital birth, and read all the studies you want. One I'd recommend is http://www.ncbi.nlm.nih.gov/pubmed/20598284 (Am J Obstet Gynecol 2011; Apr 204(4):e7-13), a meta-analysis of outcomes. Biased? Well, the authors are all doctors....but then, I haven't seen a lot of well-conducted noncertified midwife produced studies to refute it.

Yes, the skeptical OB has a LOT of good points, HOWEVER, I really really think its cruel of her to basically "showcase" home birth deaths on her blog as a "SEEEEEE! SEEEE I TOLD YOU SO" kind of tactic.

[Feberin]

I had a midwife birth in a hospital with my son and am hoping to do that again with my second child in June. I didn't really need any intervetions but I did get an iv since I labored in a jetted tub for the most of time and started getting dehydrated. I was going to get an epidural but he came too quickly. I liked that I had the option for one if I wanted it. I loved that if something went wrong I was in a hospital with a good NICU. That said if somebody wants to have a homebirth with a certified midwife then I wouldn't give them a hard time about it. I would disagree with a woman having a unassited homebirth that just seems so dangerous!

[Sinister Rouge]

Honestly, IMO, Amy Tuteur (The Skeptical OB) is full of it; she has a stick so far up her butt about home birth it's unreal. Also, I find it a bit strange that someone who claims to be a practicing medical professional has as much time as she seems to to troll blog posts and discussion boards, looking to stir shit up, as much as she does. She's like the Bill O'Reilly of the birth world - "OMG, you don't do things the way I say you should!? Well no wonder your baby died! Told ya so!" Fuck her.

Apropos of nothing ;) there is this: http://open.salon.com/blog/shaggylocks/ ... _i_said_no

She's certainly inspirational in her own way :)

[genericJname]

I wasn't able to find the full text of the actual study they were talking to, but my one concern is if they are just looking at where the actual birth took place rather than the planned location. Since the actual question that matters is whether it is or is not a safe choice to plan a home birth, hospital transfers during labor should count, because transferring appropriately is part of the standard of care. I think about 10% is generally considered an appropriate hospital transfer rate for homebirths. With the percentage for perinatal death being relatively low, little differences in design can make a big difference.

It seems like every time a study on homebirth comes out, it tips one way or the other in terms of neonatal outcome. Maternal outcome is usually going to be better with a homebirth, just because the C section rate is so much lower and most maternal deaths in the developed world are Csection related.

One of the best designed studies that I have seen on the situation in the US is the Johnson and Daviss one: http://www.bmj.com/content/330/7505/1416.full that looked at both neonatal and maternal outcomes for pretty much all attended planned homebirths in a particular year. (They made it mandatory to report data for all CPMs)