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.
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.
Being sued doesn't mean someone is a bad provider unfortunately. It can often just mean parents are mad because things weren't perfect. Also, there are some things a hospital offers that a midwife can't provide in the first 30 minutes of birth. I don't know how many homebirth providers have o2 at their deliveries and that's still a part of NRP (pending next year's changes?). I've also seen undiagnosed twin to twin transfusions and other conditions requiring an IV and blood into the baby right after birth. Intubation if necessary is done immediately after birth in a hospital, that can't be offered at homebirths (saw a nasty mec aspiration come in from home before). I realize the vast majority of patients won't need these interventions, but it is one of the differences that need to be acknowledged.
Personally, I am sick of the disrespect both sides show in this debate sometimes. Homebirth providers are all untrained hippy lunatics chanting at the moon to speed deliveries. Hospital providers are all germ covered butchers just waiting to ruin a woman's birth experience with a c-section. Puh-leeze! Both options are equally safe for certain women and both options have pros and cons, so I say let them decide for themselves and leave it at that.
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Being sued doesn't mean someone is a bad provider unfortunately. It can often just mean parents are mad because things weren't perfect. Also, there are some things a hospital offers that a midwife can't provide in the first 30 minutes of birth. I don't know how many homebirth providers have o2 at their deliveries and that's still a part of NRP (pending next year's changes?). I've also seen undiagnosed twin to twin transfusions and other conditions requiring an IV and blood into the baby right after birth. Intubation if necessary is done immediately after birth in a hospital, that can't be offered at homebirths (saw a nasty mec aspiration come in from home before). I realize the vast majority of patients won't need these interventions, but it is one of the differences that need to be acknowledged.
Personally, I am sick of the disrespect both sides show in this debate sometimes. Homebirth providers are all untrained hippy lunatics chanting at the moon to speed deliveries. Hospital providers are all germ covered butchers just waiting to ruin a woman's birth experience with a c-section. Puh-leeze! Both options are equally safe for certain women and both options have pros and cons, so I say let them decide for themselves and leave it at that.
I do agree with you, Fergus. I also realize that OB's deal with much higher risk mom's and babies, thus some bad outcomes that most likely wouldn't occur at home to lower risk mom's and babies. I wouldn't have even thought to put up the article on lawsuits if someone hadn't mentioned it before. I know there are good OB's out there. I know that many women feel more comfortable with a hospital birth for very good reasons. Like you, I just want respect to be shown for both opinions and for recognition that both are equally valid options for women. :)
Being sued doesn't mean someone is a bad provider unfortunately. It can often just mean parents are mad because things weren't perfect. Also, there are some things a hospital offers that a midwife can't provide in the first 30 minutes of birth. I don't know how many homebirth providers have o2 at their deliveries and that's still a part of NRP (pending next year's changes?). I've also seen undiagnosed twin to twin transfusions and other conditions requiring an IV and blood into the baby right after birth. Intubation if necessary is done immediately after birth in a hospital, that can't be offered at homebirths (saw a nasty mec aspiration come in from home before). I realize the vast majority of patients won't need these interventions, but it is one of the differences that need to be acknowledged.
Personally, I am sick of the disrespect both sides show in this debate sometimes. Homebirth providers are all untrained hippy lunatics chanting at the moon to speed deliveries. Hospital providers are all germ covered butchers just waiting to ruin a woman's birth experience with a c-section. Puh-leeze! Both options are equally safe for certain women and both options have pros and cons, so I say let them decide for themselves and leave it at that.
Nuchal cords occur in about 33% of deliveries, and generally cause no problems, despite the "miraculous" saves that doctors perform on babies born with a nuchal cord.
very nice... minimize the risk. for one thing, the rate of incidence is about 25%. and that's for one wrap. for *mulitple* wraps, the rate is around 1-2%.
generally cause no problems? So you consider "not breathing" to be a non problem. certainly you're aware, that besides the obvious danger of having a dead baby, nuchal deliveries are associated with spastic quadriplegia, cerebral palsy and decreased neurologic development.
so, im going to trust my baby's deliver to Ms. Dancing Dragon Moon Beams, and her uneducated superstitions? sorry, but NO THANKS.
dont get me wrong, i dont have a problem with Certified Professional Midwives who are ready to call for appropriate medical intervention as soon as it becomes necessary. And I also agree that many OB's are too quick to call for C-sections. That's why we chose an OB who only performs them at the absolute last resort.
but you'll have to excuse me when i prefer to risk a staph infection in order to have a well trained medical intervention team available within seconds, should it become necessary. As it wound up being necessary in our otherwise normal pregancy. as someone here said, "these things can turn on a dime".
generally cause no problems? So you consider "not breathing" to be a non problem. certainly you're aware, that besides the obvious danger of having a dead baby, nuchal deliveries are associated with spastic quadriplegia, cerebral palsy and decreased neurologic development.
I said, generally, don't cause problems. Not, never cause problems. I am an L&D nurse. I have seen nuchal cords result in death (usually prior to delivery). But I have also seen the vast majority of babies born with nuchal cords, need no intervention beyond slipping the cord over the head.
I'm sorry, in your child's case, that it did cause problems.
Nuchal cords occur in about 33% of deliveries, and generally cause no problems, despite the "miraculous" saves that doctors perform on babies born with a nuchal cord.
As far as those "back alley midwives", we'll have to keep an eye out for them since they are soooooo prevalent.
I had my fourth at home also. And he's a perfectly, healthy, happy 3 month old. :)
I had all four of mine at a birth center. #4 had a triple nuchal cord (very long cord) and was a precipitous delivery so he was "juicy" and purplish. The midwives did chest PT and put him on blow-by. They were vigilant, and he was ok. Had it been necessary he would have been transported, receiving the same infant resuscitation that happens in a hospital, for more critical intervention. And guess what? that's what happens at University Hospital too. Pediatricians are not standing by at every delivery in case a baby needs intubation. The nurses are trained in infant resuscitation and can bag a baby for as long as it takes for the Peds team to arrive.
I would not advocate that anyone give birth without a skilled attendant; the issue is, what constitutes "skilled"? A license by the state is one guideline, though since that is a political and economic issue it is not a fair assumption that a lack of a license means someone is not skilled. People need to do their homework which includes interviews with providers about their philosophies and their statistics, obtaining references, and researching what the *evidence* tells us about which practices are safest and best.
Had it been necessary he would have been transported, receiving the same infant resuscitation that happens in a hospital, for more critical intervention. And guess what? that's what happens at University Hospital too. Pediatricians are not standing by at every delivery in case a baby needs intubation. The nurses are trained in infant resuscitation and can bag a baby for as long as it takes for the Peds team to arrive.
guess what? the Peds team WAS standing by. when our baby was born not breathing and not moving, our OB recognized the problem, and called for the Peds team -- they were there in 5 seconds. they were set up and ready to go, while he was still cutting the cords from around our baby's neck.
(and this a normal, non-university, community hospital that delivers a lot of babies.)
what we didn't do, was have to wait for some anti-medical establishment midwife to check her ego, call for transportation, then wait for transportation to arrive, and then go through whatever amount of transportation was required before arriving at a facility with properly trained medical staff.
question: when a baby is born not breathing, how long does it take before permanent neurological damage begins to occur?
guess what? you're wrong. the resusciation team WAS standing by. when our baby was born not breathing and not moving, our OB recognized the problem, and called for the resuscitation team -- they were there in 5 seconds. they were set up and ready to go, while he was still cutting the cords from around our baby's neck.
what we didn't do, was have to wait while for some anti-medical establishment midwife to check her ego, call for transportation, wait for transportation to arrive, and then go through whatever amount of transportation was required before arriving at a facility with properly trained medical staff.
last question: when a baby is born not breathing, how long does it take before permanent neurological damage begins to occur?
Actually, DD, you are the one who is wrong through your inaccurate characterizations of midwives, their philosophies and their actions. As someone who is due to have a homebirth and has aggressively researched this subject for the past 6 years or so, let me explain to you what happens in case my baby is, God forbid, not breathing when she or he is born.
My midwife comes equipped with all the equipment necessary to get the infant breathing again. There is suction equipment, O2 tanks, the whole shabang. She is also certified in BLS and ACLS for adults and infants. It's not like she stands there and aligns my chakras and lights some incense before doing anything. Nor is she scared to activate 911. But you'd better believe she will take action, and medically appropriate action at that, whilst waiting for the ambulance to show up. She is trained to handle complications in childbirth and postpartum. If there is a cord around the neck, she is very experienced in what to do, even if it is wrapped around more than once.
The study that just came out speaks very thoughtfully and persuasively as to the safety of homebirth and CPM's. In fact, my midwife was one of the midwives involved in the study. You do not need an OB to recognize the need for providing the newborn with help breathing. And most babies, when they do get that help, get it at the home and are fine.
Not every baby in the hospital lives, either. There are no guarantees in birth, unfortunately. Having a baby at home does not put the mother and baby at greater risk for death, either. It is a shame that in our litigious and uninformed society that this belief continues to be advocated, and sometimes by those (like ACOG) who should clearly know better - after all, they have access to the research.
Okay, Ms. Doula, I wish you the best, of course. statistically speaking, the odds are on your side that everything will be allright. And if -- gods forbid -- a medical emergency does come up, I hope your Ambulance arrives quickly and the distance is short.
but please pardon my uninformed litigious ignorance, when i insist my baby and wife will have every single medical option ready and in place. Even with the most skilled and experienced midwife, I'd rather not to have to add variables such as phone lines, 911 dispatchers, EMT's, ambulance mechanics, and traffic flow patterns into an already complicated equation.
Okay, Ms. Doula, I wish you the best, of course. statistically speaking, the odds are on your side that everything will be allright. And if -- gods forbid -- a medical emergency does come up, I hope your Ambulance arrives quickly and the distance is short.
but please pardon my uninformed litigious ignorance, when i insist my baby and wife will have every single medical option ready and in place. Even with the most skilled and experienced midwife, I'd rather not to have to add variables such as phone lines, 911 dispatchers, EMT's, ambulance mechanics, and traffic flow patterns into an already complicated equation.
The *evidence* does not suggest you are safer with your choices; they simply make you feel better. And if you want to base your decisions on how you feel rather than what the evidence shows, why not light some incense and chant a little while you're at it?
"I mean these people claim "electronic fetal monitoring" is somehow A Bad Thing."
DD--I actually had a conversation regarding electronic fetal monitoring with a maternal-fetal specialist who happens to be a leader in his field--interesting that he strongly felt that there was no evidence to support the use of electronic fetal monitoring and that the only ones to benefit from the practice were the lawyers.
I am very glad that your baby was OK and that you feel comfortable with the choices you made...your lack of respect for other equally valid choices is appalling.
fergus51
6,620 Posts
Being sued doesn't mean someone is a bad provider unfortunately. It can often just mean parents are mad because things weren't perfect. Also, there are some things a hospital offers that a midwife can't provide in the first 30 minutes of birth. I don't know how many homebirth providers have o2 at their deliveries and that's still a part of NRP (pending next year's changes?). I've also seen undiagnosed twin to twin transfusions and other conditions requiring an IV and blood into the baby right after birth. Intubation if necessary is done immediately after birth in a hospital, that can't be offered at homebirths (saw a nasty mec aspiration come in from home before). I realize the vast majority of patients won't need these interventions, but it is one of the differences that need to be acknowledged.
Personally, I am sick of the disrespect both sides show in this debate sometimes. Homebirth providers are all untrained hippy lunatics chanting at the moon to speed deliveries. Hospital providers are all germ covered butchers just waiting to ruin a woman's birth experience with a c-section. Puh-leeze! Both options are equally safe for certain women and both options have pros and cons, so I say let them decide for themselves and leave it at that.