How Safe Is Home-Birth? Ctd

Sep 16 2013 @ 2:58pm

A doctor writes:

Home-birth is every bit as dangerous as Laura Helmuth expected. The most comprehensive figures to date were collected by the state of Oregon, when home-birth midwives refused to release their death rates to the state. Oregon asked Judith Rooks, a certified nurse-midwife, to analyze the data, and what she found was appalling. The death rate from planned home-births with a licensed Oregon home-birth midwife was 800% higher than comparable risk hospital birth. Below is the chart that she included in her testimony before the Oregon legislature:

homebirths

By the way, the Cochrane Review that you cited is worse than useless. They drew their conclusions from only eleven home-births. The data above was derived from 2000 home-births.

The Midwives Alliance of North America, the organization that represents home-birth midwives, has collected data on 28,000 home-births attended by their members. They have publicly released the C-section rate, intervention rate, transfer rate and prematurity rate, but they refuse to release the death rate. It doesn’t take a rocket scientist to figure out that they are hiding the death rate because it is extraordinarily high. Even home-birth midwives know that home-birth has a high death rate. They just don’t want the American public to find out.

Another reader:

I am a mother of three and a trial lawyer representing children injured during labor and delivery by obstetrical or nursing negligence. I recoil at the relentless drive of the right wing to control or limit the healthcare options of women, but when it comes to home birth, my job makes it impossible for me to view it as a wise choice for anyone.

My clients all had normal pregnancies, healthy babies, and developed difficulties during labor and delivery that warranted a C-section. No one knows what will happen in any given labor, and a healthy pregnancy is no guarantee you won’t draw that black bean. When a C-section is called for but delayed, the results can be tragic. My infant clients who were denied a timely C-section often have hypoxic ischemic encephalopathy, a condition where child will never walk, talk, eat, or be self-sufficient. Their families courageously soldier on through every day but their lives are never close to normal again. Other children in the family are always neglected. Often the couples divorce because the stress of becoming a nurse to a severely disabled child is just too much to bear. Every simple task is a strain. The medical care costs are enough to bankrupt anyone, and as a result, most families do without help because they can’t afford it.

Of course, you can’t always avoid this fate by being in a hospital, but it’s far more likely that a baby in distress will experience a dangerous, avoidable delay in delivery if the mother isn’t even AT a hospital. If home-birthers could see one day in my clients’ lives caring for a brain-injured child, I doubt they’d be so gung-ho. Someone should tell these women to stop gambling with their babies’ lives. The reason birth morbidity and mortality rates are so much lower now than in 1800 is because of medical advances, not because people avoid them.

Can you have a safe home birth? Maybe, if you’re lucky. I just can’t see how anyone’s preferences for a kumbaya birth experience that lasts for a few hours could outweigh a baby’s right to a normal, healthy life.

By the way, I don’t think most women will get any pushback if they refuse an epidural or drugs in the hospital. And I’ve had many friends deliver drug-free in hospitals.

On that note, another reader:

When my daughter was born, we were at the “baby factory,” home to the largest neonatal unit in a sizable city. Approximately a month before the birth, we took a tour of the facility, where they make a point of telling you all the options: lying down, squatting, water birth … the only thing NOT mentioned were drugs. There was, of course, discussion of C-section, and a show of the operating rooms. We were encouraged to pre-select our music/movies that we would like to e played during, and told that midwives were welcome. (we did not use a midwife).

The day of the birth my wife’s contractions were carefully monitored. Our nurse came in, noticing the scale of the contractions, and commented that the intensity suggested that the pain “was probably a 9 or a 10.” A nod through clenched teeth confirmed this assessment. The nurse then offered remedies: ice chips, waking around, shifting positions. Conspicuously absent: medication.

But we were big fans of better living through chemistry, so I offered that we would like drugs. The nurse smiled and then fetched the doctor. It was then later explained: they are specifically trained NOT to offer medication; we had to positively request it.

I heard so much strange advice during my wife’s pregnancy, but the one thing I have no patience for are people who insist that hospitals systematically force people away from their wishes. Every person we met at this alleged “system” was specifically trying to give us the widest berth to do it our way, while caring for our and our daughter’s health. We has a wonderful staff of people who genuinely respected our choices, but did so in an environment fully prepared to handle any eventuality.

I have no issues with midwives or those who use them – except with they claim that people who choose in perinatal medicine as their career, a truly exhausting job where you see people in very high stress who are not at their best, and you get a lot of irrational abuse, are interested in nothing more than pumping new mothers full of drugs. They deserve better.

Another looks at the middle ground between birthing at home and the hospital.

My wife and I have three children, all of whom were born in “home away from home” birthing centres at hospitals in London. The rooms are made up like spacious bedrooms with double beds and comfortable furnishings. My wife was able to deliver each of our children, with support from a midwife, in an environment that combined much of the informality of a home birth with immediate access to nurses, doctors, and medical equipment should they prove themselves necessary. The staff avoided medical terminology, introduced themselves by their first names, and gently and regularly reminded us that mum is not a patient, is not sick, and that pregnancy and birth are part of healthy life.

Several weeks before, we’d been shown around and saw the crash cart and noted the double doors that separated the centre from the hospital proper. The process of admission was explained to us. We were visitors unless something required medical intervention. Only then would my wife/baby would become patients of the university hospital. My wife was able to give birth comfortably and naturally and reassured.