Studies Support Home Birth Option

[jamistlc]

ackermann-liebrich u et al. home versus hospital deliveries: follow up study

of matched pairs for procedures and outcomes. bmj, 1996;313: 1313-1318.

during delivery the home birth group needed significantly less medication

and fewer interventions whereas no differences were found in durations of

labour, occurrences of severe perineal lesions, and maternal blood loss.

conclusion: "healthy low risk women who wish to deliver at home have no

increased risk either to themselves or to their babies."

albers ll, katz vl. (1991). birth setting for low-risk pregnancies. an

analysis of the current literature. j nurse midwifery, 1991; 36(4): 215-20.

the authors concluded that "nontraditional birth settings present advantages

for low-risk women as compared with traditional hospital settings: lower

costs for maternity care, and lower use of childbirth procedures, without

significant differences in perinatal mortality."

anderson re, anderson da. the cost effectiveness of home birth. j nurse

midwifery, 1999; 44(1): 30-35.

"the average uncomplicated lady partsl birth costs 68% less in a home than in a

hospital, and births initiated in the home offer a lower combined rate of

intrapartum and neonatal mortality and a lower incidence of cesarean

delivery."

anderson re, murphy pa. outcomes of 11,788 planned home births attended by

certified nurse-midwives. a retrospective descriptive study. j nurse

midwifery, 1995; 40(6); 483-492.

for those planning a home birth when labor started, the intrapartum and

neonatal mortality rate was 2 per 1,000, falling to 0.9 per 1,000 when

deaths associated with congenital abnormalities were excluded.

burnett ca et al. home delivery and neonatal mortality in north carolina.

jama 1980;244(24):2741-2745.

excluding infants weighing 2000 g or less at birth, the neonatal mortality

rate for hospital deliveries in north carolina was 7 per 1000 and for

midwife-attended home births it was 4 per 1000. women attended by midwives

were more likely to be demographically high risk.

chamberlain g, wraight a, crowley p, (eds). birth at home: the report of the

1994 confidential enquiry by the national birthday trust. pract midwife

1999;2(7):35-9.

5971 women planning home births at 37 weeks' gestation were matched with

4724 women planning hospital delivery. the cesarean rate was 2.0% for home

births, 4.1% for hospital births. the rate of operative delivery (forceps,

vacuum) was 2.4% for home, 5.4% for hospital. 5.2% of babies planned for

home birth, including transfers, had 1-minute apgar scores >7, compared to

9.3% of planned hospital babies. perinatal death rate was too low for both

groups to allow meaningful comparison; both groups were below the national

rate. exclusive breastfeeding rates at six weeks postpartum were 65% for

planned home births and 44% for planned hospital births.

conclusion: "in essence it seems that a woman who is appropriately selected

and screened for a home birth is putting herself and her baby at no greater

risk than a mother of a similar low-risk profile who is hospital booked and

delivered." the study included 53 mothers planning home birth after

cesarean.

duran, am. the safety of home birth: the farm study. am j public health

1992;82(3): 450-452.

the farm cesarean rate was 1.5% versus 16.5% for the u.s. (the farm midwives

have attended vbacs since 1985. this study included deliveries from

1971-1989.)

"based on rates of perinatal death, of low 5-minute apgar scores, of a

composite index of labor complications, and of use of assisted delivery, the

results suggest that, under certain circumstances, home births attended by

lay midwives can be accomplished as safely as, and with less intervention

than, physician-attended hospital deliveries."

janssen pa, holt vl, myers sj. licensed midwife-attended, out-of-hospital

births in washington state: are they safe? birth, 1994; 21(3): 141-148.

"the results of this study indicate that in washington state the practice of

licensed non-nurse-midwives, whose training meets standards set by

international professional organizations, may be as safe as that of

physicians in hospital and certified nurse-midwives in and out of hospital."

(note: my primary birth attendant meets the requirements for licensure in

washington state.)

mehl le at al. outcomes of elective home births: a series of 1,146 cases. j

reprod med 1977;19(5): 281-290.

the cesarean rate was 2.4% compared with a california primary cesarean rate

of about 5%. the forceps rate was 1.5% the episiotomy rate was 7.8% and

12.9% of women had lacerations requiring repair. the perinatal mortality

rate was 9.5 per 1000 versus 20.3 per 1000 for california.

murphy pa, fullerton j. outcomes of intended home-births in nurse-midwifery

practice: a prospective descriptive study. obstet gynecol, 1998; 92(3):

461-470.

"home birth can be accomplished with good outcomes under the care of

qualified practitioners and within a system that facilitates transfer to

hospital care when necessary. intrapartal mortality during intended home

birth is concentrated in postdates pregnancies with evidence of meconium

passage." "this study supports previous research indicating that planned

home birth with qualified care providers can be a safe alternative for

healthy low-risk mothers."

northern region perinatal mortality survey coordinating group. collaborative

survey of perinatal loss in planned and unplanned home births. bmj 1996;313:

1306-1309.

perinatal mortality in planned home births "was less than half the average

for all births, and few of these deaths were associated with substandard

care."

olson o. meta-analysis of the safety of home birth. birth, 1997; 24(1):

4-13.

included six controlled studies covering 24, 092 mainly low-risk women

planning home or hospital births. perinatal mortality was not significantly

different between the planned home and planned hospital groups, but the

planned home birth group had fewer low apgar scores and fewer severe

maternal lacerations. there was less intervention in the planned home birth

group: fewer inductions, fewer episiotomies, fewer assisted deliveries, and

fewer cesareans.

"home birth is an acceptable alternative to hospital confinement for

selected pregnant women, and leads to reduced medical interventions."

schlenka p. safety of alternative approaches to childbirth. unpublished

doctoral dissertation, stanford university, 1999. available online:

http://www.domiciliary.org/freedom/@birth/meadsum.html.

conclusions: "...low-risk women who opt for a natural childbirth in an

out-of-hospital setting will experience a slightly though not significantly

lower perinatal mortality than low-risk women who opt for a hospital birth

under the management of an obstetrician, including the unfavorable results

for transfers from home to hospital. our data also suggest that even for the

high-risk levels of our study population the natural approach produces the

same perinatal mortality outcomes as the obstetric approach. given no

differences in perinatal mortality it must be noted that the natural

approach shows significant advantages with respect to lower maternity care

cost as well as reduced mortality and morbidity from unnecessary cesareans

and other obstetric interventions, and significant benefits from avoiding

negative long-term consequences from unnecessary obstetric interventions and

procedures."

tyson h. outcomes of 1001 midwife-attended home births in toronto,

1983-1988. birth, 1991; 18(1):14-9.

spontaneous lady partsl delivery rate was 93%, including transfers. the forceps

rate was 3.4%, and the cesarean rate was 3.5% among all lady partsl births,

17.9% had episiotomies, of which most were performed by physicians at

hospital births. only 0.5% had third-degree lacerations and 55.2% had an

intact perineum. perinatal mortality rate was 2/1001. at 28 days postpartum,

98.6% of mothers were fully breastfeeding.

woodcock hc, read aw, bower c, stanley fj, moore dj. a matched cohort study

of planned home and hospital births in western australia 1981-1987.

midwifery, 1994;10(3):125-35.

women in the home birth group had longer labors but were less likely to have

induction, cesarean, or other operative delivery; and less likely to have

other interventions overall. babies in the home birth group were in better

condition at birth. hospital babies were more likely to take a while to

start breathing, to need resuscitation, and to have apgar scores lower than

8. perinatal mortality was higher overall in the home birth group, but it

was not statistically significant. neonatal mortality was significantly

higher in the hospital birth group.

"key conclusions: planned home births in western australia appear to be

associated with less overall maternal and neonatal morbidity and less

intervention than hospital births."

also, you could certainly get marsden wagner or lewis mehl to comment as obs

on the safety of home birth. if you want, i'll look up their email addresses for you.

[Nursz-R-Awsm]

I am considering it. Nervous however...nullipara and can't seem to find a midwife where I live. I also work in a hospital.

[mzjennifer]

I have recently started to give this some thought....even though I work in L&D in a hospital, I would be very interested in delivering at home if I have a 3rd child. After seeing just how much intervention goes on (and, in my opinion, is not necessarily warranted in every case), I've seriously given homebirth some thought.

But definitely NOT an unassisted homebirth. It's much better to have a CNM there to monitor just in case something goes wrong. I've read some websites that advocate unassisted homebirths, and that just scares me - thinking about what COULD go wrong...why oh why would a sensible woman want to give birth without a CNM present at home??

[jamistlc]

Originally posted by mzjennifer

I have recently started to give this some thought....even though I work in L&D in a hospital, I would be very interested in delivering at home if I have a 3rd child. After seeing just how much intervention goes on (and, in my opinion, is not necessarily warranted in every case), I've seriously given homebirth some thought.

But definitely NOT an unassisted homebirth. It's much better to have a CNM there to monitor just in case something goes wrong. I've read some websites that advocate unassisted homebirths, and that just scares me - thinking about what COULD go wrong...why oh why would a sensible woman want to give birth without a CNM present at home??

There are many Midwifes who are not a CNM, please note the DEM, CPM, and LM credentials as well!

I would like to direct your attention to this URL it contains factual information on why and how to have a homebirth from a CCE!

http://www.findarticles.com/cf_dls/m0838/1999_May/54622617/p1/article.jhtml

[mzjennifer]

>>>>

First, please excuse me for not cutting and pasting the above quote the way that everyone else does...I'm still trying to figure out this board.

Second, in my state, as far as I know, the only recognized midwives (legally) are CNM's. I know that there are other highly skilled midwives who are not CNM's that practice in my state (and other states). But, I also consider legalities in this state to be important. I would not feel comfortable giving birth with a midwife that is not legally recognized, due to many legal implications. Does my state need better legislation to include these also highly skilled midwives as practitioners -- YES! I hate how legalities vary from state to state. When I decided that I wanted to be a midwife, I wanted to go straight into it and not become a nurse first....but in my state, that is the only way to do it and be legal. Now that I am a nurse, I have to say that I am glad that I got the basic background of nursing school to learn about all of the different illnesses, diseases, treatments, etc. I feel that nursing will give me a wider knowledge base in which to build my midwife career.

All in all...I do support all midwives, whether CNM, LM, DEM or CPM. I wish we could introduce better legislation in my state to standardize all midwives.

'Nuff said

[jamistlc]

Originally posted by mzjennifer

>>>>

First, please excuse me for not cutting and pasting the above quote the way that everyone else does...I'm still trying to figure out this board.

Second, in my state, as far as I know, the only recognized midwives (legally) are CNM's. I know that there are other highly skilled midwives who are not CNM's that practice in my state (and other states). But, I also consider legalities in this state to be important. I would not feel comfortable giving birth with a midwife that is not legally recognized, due to many legal implications. Does my state need better legislation to include these also highly skilled midwives as practitioners -- YES! I hate how legalities vary from state to state. When I decided that I wanted to be a midwife, I wanted to go straight into it and not become a nurse first....but in my state, that is the only way to do it and be legal. Now that I am a nurse, I have to say that I am glad that I got the basic background of nursing school to learn about all of the different illnesses, diseases, treatments, etc. I feel that nursing will give me a wider knowledge base in which to build my midwife career.

All in all...I do support all midwives, whether CNM, LM, DEM or CPM. I wish we could introduce better legislation in my state to standardize all midwives.

'Nuff said

I agree Nursing does give you a wider knowledge base, as any training does! It is useful but not required since we are talking about a natural process. I think it may give you more options for interventions and better assessment skills but Midwifery programs offer this training also, the ability to regnize something is amiss, deviations from the norm! As far as not recognized I can relate in Ohio DEM is not recognized only CNM! But we have them here practicing openly, look at my club for links! I bet you have them there too!

Peace,

Jami

[jamistlc]

Someone posted to the poll they would have an unassisted childbirth. Not me or my partner, noway there is to many variables that can turn bad, very bad!

[debi538]

Not only would I...I did have a home birth 17 years ago........It was the best experience I ever had. I wish I had considered it seriously with my other 3 births. Being at home with my other children and newborn was so wonderful in those early morning hours after Emily's birth. My most treasured picure was one of my 4 children cuddled in my bed a few hours after Emily's birth.

Because of the state laws, my midwife was an unlicensed direct entry midwife. She was a great support, as was my backup physician who saw me prenatally.

I wish all new mothers had the knowledge and support to make intelligent birth choices and the availablilty of a variety of services. I am a childbirth educator, OB RN and Lactation Consultant. The vast majority of hospital births are controlled with little choice truely given to the mother. I have a hard time believing that over 40% require pitocin augmentation or induction and that the vast majority of women NEED epidurals.

[rdhdnrs]

I can see the advantages and why someone would want a home birth. I guess after five years as an RN in L&D I am too "medicalized", but the thought of a home birth scares me to death. I have taken care of the aftermath of too many failed attempts.

The studies support home birth under the care of qualified personnel, with ready access to hospital transfer. In reality, it doesn't always work this way. I have taken care of horrible cases of chorio from prolonged rupture, devastating postpartum bleeding, lacerated cervix from pushing too soon. One woman came in who had been pushing for 12 hours!!!! All these started out as home births.

It just seems there needs to be more regulation around who is allowed to manage these pregnancies and births.

Lisa

[jamistlc]

Originally posted by rdhdnrs

I can see the advantages and why someone would want a home birth. I guess after five years as an RN in L&D I am too "medicalized", but the thought of a home birth scares me to death. I have taken care of the aftermath of too many failed attempts.

The studies support home birth under the care of qualified personnel, with ready access to hospital transfer. In reality, it doesn't always work this way. I have taken care of horrible cases of chorio from prolonged rupture, devastating postpartum bleeding, lacerated cervix from pushing too soon. One woman came in who had been pushing for 12 hours!!!! All these started out as home births.

It just seems there needs to be more regulation around who is allowed to manage these pregnancies and births.

Lisa

Okay, I see a little education about certification for a "Lay Midwife" is appropriate here. There are many types of Midwifes in the Lay world. They can be from someone who thinks they are a midwife and states they are (LOL) to the Certified Professional Midwife (CPM). It is the latter who will oneday in all probability be the national standard for all MIDWIFES CNM included. MANA, ACNM, NARM and other Midwifery organizations are working collaboratively to make this happen without stepping on each others toes. Very hard since Nurses can be just as territorial as the MD counter parts in OB or Midwifery!

There are other designations like LM which is a Licensed Midwife (only in states that are regulated for DEM's regulated) Direct Entry Midwifes (DEM) can be any Midwife from the one who just hangs out a shingle to the one who went to college for a Midwife program and got the CPM! Yes it is an unregulated industry in many states since the state will not recognize the Midwife in the first place unless they are a CNM. By the way most CNM's do not practice Homebirths d/t "No Medical Back-up). Why no back up becuase the hospital will revoke physicians privledges who will provide this service for the CNM. It is a catch 22!

So the only way to make this a safer option is to invoke a Nationally recognized certification process that will allow these other Midwifes to practice and remain in the realm of Homebirthing. This as I see it is the CPM platform as the national recognized "Midwife"! CPM uses the same board examination as the CNM boards, in fact it is the exact same exam!