Home births 'as safe as hospital'

  1. From BBC---

    Home births 'as safe as hospital'


    The largest study of its kind has found that for low-risk women, giving birth at home is as safe as doing so in hospital with a midwife.

    Research from the Netherlands - which has a high rate of home births - found no difference in death rates of either mothers or babies in 530,000 births.
    Interesting that in Holland 1/3 of women choose homebirth, hence the study. Read the below quotes from article...

    The research was carried out in the Netherlands after figures showed the country had one of the highest rates in Europe of babies dying during or just after birth.

    FROM THE TODAY PROGRAMME


    More from Today programme
    It was suggested that home births could be a factor, as Dutch women are able and encouraged to choose this option. One third do so.

    But a comparison of "low-risk" women who planned to give birth at home with those who planned to give birth in hospital with a midwife found no difference in death or serious illness among either baby or mother.

    "We found that for low-risk mothers at the start of their labour it is just as safe to deliver at home with a midwife as it is in hospital with a midwife," said Professor Simone Buitendijk of the TNO Institute for Applied Scientific Research.

    "These results should strengthen policies that encourage low-risk women at the onset of labour to choose their own place of birth."
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  3. by   azhiker96
    Interesting article. I'm impressed at the even-handed reporting. They also noted,
    Nearly a third of women who planned and started their labours at home ended up being transferred as complications arose
    The group who chose to give birth in hospital rather than at home were more likely to be first-time mothers or of an ethnic minority background - the risk of complications is higher in both these groups.
    The study did not compare the relative safety of home births against low-risk women who opted for doctor rather than midwife-led care.
    As long as patients are aware of the risks/benefits, I think home births are a fine option.
  4. by   rph3664
    I live in an area with a large Amish population, and most of their babies are born at home, delivered by lay Amish midwives, and they rarely have prenatal care unless complications obvious to them arise. But those midwives really know what they are doing, and know when to send Mom to the hospital.

    The biggest problem I'm aware of with this, and once again it's mostly among the Amish, are babies contracting Group B strep from their mothers during delivery.
  5. by   mamafeliz
    It's also critical to note that standards of practice for Dutch midwives are very clear. All multiples, breech presentation, previous cesarean must be managed by OBs in the hospital. Home birth can be safe with clear risk criteria, early transport if troubles arise, collaborative relationships between home and hospital birth providers. Sadly, the safe stats quoted from studies done in the Netherlands or BC do not apply to home birth practice in the US.
  6. by   FireStarterRN
    That's because homebirths are effectively repressed by the American Medical Association, which seems to want a commercial monopoly on all births in the United States.
  7. by   mamafeliz
    ACOG certainly came out with a a statement against home birth, ignoring sound research coming out of countries where Midwifery is regulated and comprehensively integrated into essentially all OB care. But home birth can look entirely different depending on which state in the US you are talking about. As we know, direnct entry midwifery(DEM)/home birth is even outlawed in some states.

    In my home state, DEMs can legally choose to practice unlicensed, or if they are interested in getting medicaid/insuurance reimbursement, they can seek state licensure. With state licensure, they are held to following spelled out Standards of Practice. The problem is that the Standards of Practce allow high risk conditions such as breech and multiples to be managed at home. Within the meeting notes of the Board overseeing the practice of these licensed midwives, there are multiple reports of fetal losses specifically related to these practices. The consultation that is required can take place with another midwife or Naturopath, neither of whom have hospital privileges. This mixed with NO mandatory system of data collection of outcomes has created a bit of a mess. A group of us L and D nurses, home birthers all, who desire to see the expansion of home birth option to more women, first want to see safe practice established and data collection mandated. There must be transparency in practice and outcomes. Unfortuanately, thie Board of Licensure has a DEM majority, and they have unfortunately chosen to resist changes which would create more safety for families choosing home birth options. This has not helped their cause of professionalism.

    Meanwhile, we are working on the hospital end to help "bridge" between home and hospital so transports go more smoothly, DEMs don't wait so long to transfer. Another critical factor to success of home birth practice is early transport. It is clear DEMs often defer transport because awful reception and scrutiny received from the hospital workers.

    The US has plenty of work and major cultural shifts before we mirror the duutch OB system
  8. by   DeLana_RN
    I agree, with the European midwife model (they are actually well-trained and apprenticed, unlike many U.S. lay midwives who sometimes operate underground) home births can be very safe.

    But no one has a crystal ball and knows when an unexpected a crash c-section will be necessary; even a quick transfer to a hospital may then be too late to prevent brain damage in the infant (or worse)*. If you're among the tiny percentage who do have an unfavorable outcome, would you not always wonder what might have been? (Of course, the same might be said about women who choose vaginal birth in a hospital when a c-section had been advised and problems occur).

    Of course, everyone is comfortable with a different level of risk. I just wonder if women always understand the unexpected complications that can arise at a "low risk" birth.

    DeLana

    *In Germany in the 50's and 60's, home births were standard for all "normal" pregnancies. However, of the 8 children in the family of a good friend of mine, all born at home during these decades, 2 are MR (most likely caused by hypoxia during the birth process).
    Last edit by DeLana_RN on Apr 20, '09
  9. by   rph3664
    My uncle was born at home in 1930, and while I never found out exactly what happened, his birth was extremely difficult and if they had been in a hospital, Grandma would have had a c-section. In 1930! The doctor recommended that any future children be born in a hospital, and that's where my other uncle was born in 1932 and my mom in 1933 - both without any complications. So what became of my uncle? He's 78 years old, a retired insurance executive whose job called for frequent travel to Europe, was salutatorian of his high school class, and left for an Elderhostel to Thailand and Vietnam two days after the tsunami (the area where he went was not affected by this). Babies are tough creatures.

    If I had had kids, the two things that would have steered me away from this are post-partum hemorrhage and shoulder dystocia. No, I don't work in OB but have known plenty of women who have experienced those very unpredictable complications.

    For the record, my mother had three uncomplicated vaginal deliveries.
  10. by   cmonkey
    A properly prepared midwife will carry pitocin for pph, and the Gaskin maneuver is more than likely going to resolve a shoulder dysotcia. Since women birthing at home can't have an epidural, getting her onto her hands and knees to free up a stuck baby is much easier. This is not to say that it will resolve *all* dystocias, of course, but more often than not, it will. I don't expect you see it used a lot in hospitals, but it's standard in homebirths with well-trained midwives.

    I had my second and third kids at home (last one in November) and I can't imagine willingly delivering in the hospital barring pre-existing conditions that require it.
  11. by   KateRN1
    The US has the highest rate of obstetric interventions, yet one of the poorest records regarding outcomes amongst industrialized countries. Countries where midwives are the keepers of normal birth, whether in the home or hospital settings, have lower rates of interventions and better outcomes. It's really quite simple. There's no need for a pathologist (an OB, a subspecialty of surgery) until there's something pathological to treat. The prevailing idea here that "normal birth is a retrospective diagnosis" is harming our mothers and babies.

    Many of the "complications" that healthcare providers see in the L&D wards are directly caused by the healthcare environment: lack of 1:1 support, immobility, forced dependence, and dependence on machines rather than physical assessment skills. Shoulder dystocia is most commonly a problem of positioning rather than cephalopelvic disorder and neonatal breathing issues are often a problem of aggressive hydration of the mother (fluid overload) for the ever-present epidural. Time and time again, studies prove that the single greatest intervention in labor is continual support for the laboring mom, yet nurses spend very little time at the bedside *in contact with the mother,* with the attention going to the "machine that goes ping."

    I would suggest that anyone considering a career in obstetrics (or considering having a baby) should read two books: Henci Goer's The Thinking Woman's Guide to a Better Birth and Rima Apple's Perfect Motherhood: Science and Childrearing in America. You did (will) not learn everything you need to know about birth in nursing school or in OTJ training.

    *I've had two hospital births. The first was a typical induction for post-dates (three weeks post EDD) and the second was a cesarean after 80 hours of labor at home, in water. Not all transfers from homebirths are for "complications" or emergencies. In fact, very few are true emergencies.
  12. by   Halinja
    We aren't using evidence based practice in the US L&D units. For instance, there is no evidence that frequent monitoring of fetal heart tones improves outcomes. It improves C/S rates, but NOT outcomes. But...in both the hospitals and doctors defense, it is the attorneys who are driving a lot of OB practice. I'm pretty sure it is the most litigious of medical specialties. You can sue the OB for wrongful birth 18 years later if your kid doesn't seem to be doing well. Malpractice insurance is through the roof for practitioners. So I can see why the specialty leans towards medical intervention and constant monitoring. You never know when someone is going to second guess your practice years later.

    I really regret the tendency to medicalize birth. But I can see why it has happened. Yeah, AMA might not like midwives. But the public is driving the trend with lawsuits.

    *I had three hospital births and one at home. Loved the one at home.
  13. by   rwbabycatcher
    Complications happen in hospitals too (hospital aquired infections! hemorrhage as a complication of C-section!). As they teach you in nursing school, it's all about the risk/benefit ratio. Both home and hospital come with their own sets of risks and benefits. Women should be able to make their own decision about where they give birth, but in our society this is a rarity. Not only are women not empowered (we never talk about birth until the woman is actually pregnant, and sometimes not much even then), but in many places there are just no options other than the hospital.
  14. by   jessi1106
    Thanks for posting the article. Certainly lots to say on this topic...but as both a home-birthing momma and as a nurse...I greatly appreciate it...and I have to say almost NOTHING (so far in my life) can top eating popsicles, while laboring in my own bed, and between pushes with my older daughter!!

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