BMJ Study Released on Homebirth

Published

Hi everyone -

Here is the abstract and link to the new study put out on homebirth with CPM's. The largest study to date. Unlike the study done by Pang et al. in Washington, which was so poorly done as to be laughable (yet still published in a respected medical journal), this one seems to be well done and confirms what other studies have had to say about homebirth and the safety of midwives. I'll be interested to see what Henci Goer has to say about this study.

http://www.seattlemidwifery.org/news_BMJarticle.pdf

Conclusion: Planned homebirth for low risk women in North America using certified professional midwives was associatedwith lower rates of medical intervention but similar intrapartum and neonatal mortality to that of low risk hospital births in the United States.

Alison

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

This does not surprise me; in most other industrialized, advanced countries(besides the USA), homebirth is considered the norm for healthy, low risk pregnancies and moms. I do believe in ANY birth case, the good care of a competent provider (midwife/nurse or doctor) is key to safe, healthy delivery, no matter the venue. That fewer interventions occur in homebirth is a given, obviously.

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That fewer interventions occur in homebirth is a given, obviously.

That jumped out at me too.

Interesting about infant mortality . . . having lost a baby this week. I can't remember the last time that happened - it has been years for us.

steph

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
That jumped out at me too.

Interesting about infant mortality . . . having lost a baby this week. I can't remember the last time that happened - it has been years for us.

steph

For us also. Infant/neonatal mortality rates are really shameful in the USA in general, compared to other equally-industrialized nations. I think we do not place children high enough on our list of priorities anyhow, but I digress.

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Hi everyone -

Here is the abstract and link to the new study put out on homebirth with CPM's. The largest study to date. Unlike the study done by Pang et al. in Washington, which was so poorly done as to be laughable (yet still published in a respected medical journal), this one seems to be well done and confirms what other studies have had to say about homebirth and the safety of midwives. I'll be interested to see what Henci Goer has to say about this study.

http://www.seattlemidwifery.org/news_BMJarticle.pdf

Conclusion: Planned homebirth for low risk women in North America using certified professional midwives was associatedwith lower rates of medical intervention but similar intrapartum and neonatal mortality to that of low risk hospital births in the United States.

Alison

We have different types of midwives in seattle, washington. I would be inclined to trust certfied nurse midwives, but the other type (non-RN's) do not receive the same training -- they are lay midwives that learn via an apprenticeship & minimal education. I wonder if there are any studies comparing the different types of midwives?

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We have different types of midwives in seattle, washington. I would be inclined to trust certfied nurse midwives, but the other type (non-RN's) do not receive the same training -- they are lay midwives that learn via an apprenticeship & minimal education. I wonder if there are any studies comparing the different types of midwives?

This study specifically looked at births with non nurse midwives. CPMs/certified professional midwives or direct entry midwives- or "lay" midwives as you call them.

It's a good study, well written, lots of good info.

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We have different types of midwives in seattle, washington. I would be inclined to trust certfied nurse midwives, but the other type (non-RN's) do not receive the same training -- they are lay midwives that learn via an apprenticeship & minimal education. I wonder if there are any studies comparing the different types of midwives?

Actually, licensed CPM's go through very extensive training programs, minus the nursing school. They learn their field, instead of spending 4 years in a nursing program.

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Interesting about infant mortality . . . having lost a baby this week. I can't remember the last time that happened - it has been years for us.

steph

Do you mean after delivery? We lost one at birth several months ago, but we have many demises, unfortunately. :o

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Do you mean after delivery? We lost one at birth several months ago, but we have many demises, unfortunately. :o

Yes, after delivery.

steph :o

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We have different types of midwives in seattle, washington. I would be inclined to trust certfied nurse midwives, but the other type (non-RN's) do not receive the same training -- they are lay midwives that learn via an apprenticeship & minimal education. I wonder if there are any studies comparing the different types of midwives?

If you look at the study, it focused on non-nurse midwives. So the results are very impressive indeed. And yes, statistics have been compared comparing CPM's vs. CNM's, and there have been times when the CPM's were getting better results and higher rates of client satisfaction. If you check out the Midwife Alliance of North America, they cite studies and statistics regarding direct entry midwives. Being a nurse does not necessarily make for better outcomes. What makes for better outcomes is the midwifery model of care, and having strong physician and hospital backup in the case of transfer.

Um, as far as the idea that there is minimal education involved, have you ever taken a look at the curriculum for Seattle Midwifery School or some of the other midwifery schools? They're 3 years long, which is longer than the 2 year masters program the CNM's get. Far from flaky. And apprenticeship has long been honored as an entry into many professions, so I'm not sure we can diss the direct entry midwives simply because they're not getting a masters degree and they're not nurses.

A study was done comparing nurse and non nurse doulas. Those doulas that had medical training were LESS effective than those who didn't. Having a medical backround doesn't always confer advantages - sometimes it simply instills a mindset of fear which is then confirmed by watching medical managemnt of pregnancy.

I highly encourage all L&D nurses to observe birth in a variety of settings. The difference can be profound, and even if you choose to work in the hospital setting, it can be transformative to watch a homebirth and a birth center birth. I do NOT count hospital based "birth centers" as real birth centers, either. I count a birth center as a free standing facility without direct ties to hospitals other than transfer privileges. I think that the term birth center has been used very irresponsibily by many hospitals, and it's more of a marketing move than anything.

In any case, it was a cool study. And I agree, as usual, with SBE. America has a shameful reputation when it comes to taking care of pregnant women and their babies. And we spend the MOST per capita on pregnancy and birth than any other nation. We're doing something very wrong.

Alison

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Specializes in LTC/Behavioral/ Hospice.

This is more great news for women who decide to homebirth. I had my 4th child at home, with a CPM and had a very healthy little boy, no interventions and no complications, which is all I ever wanted. :) I remember that I had to always have my facts straight and my speech on why homebirthing is safe ready to go, though, as just about anyone who knew I was homebirthing questioned my decision and some people even went so far as to insinuate that I was being selfish and unsafe. Let's hope that this study makes it to the general public so that more people can understand that homebirthing is a reasonable option for many women. :)

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I wonder if there are any studies correlating the use of pitocin to the less than desirable outcomes in childbirth. It occured to me reading this thread that maybe (and I don't know for sure) the US - and hospitals in general - uses a lot of this medication during labor.

As far as CNMs, I find in our facility that they are almost (but not as quick) to use pitocin, c/s, or VEs as the OBs. It's almost like they're influenced by them. They aren't what I had in my mind that midwives would be. But then whenever we get a birth center transfer, the midwives from that facility come with the pt and stay in the room w/them til delivery.

I'd love to visit a birth center and learn from them. I'm so new in L&D and already feel biased to medical interventions. Like, ready and willing to use them. I had a pt today and the OB was ready to use forceps or c/s in 45 min if no progression. My manager came in to help push and with her 20+ yrs experience and lots of prayers, that baby was born 20 min later. The OB kept saying, "I can't believe she delivered lady partslly. I had already called for the c/s."

Wow.

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