Studies Support Home Birthing 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.

[JewelStream]

I have had 2 hb's now and they were so wonderful that I'd never step foot in the hospital. If pg and birth were treated more as a normal part of the life cycle instead of an illness, birthing would be much less traumatic in the hospital.

I know that hb is not for everyone, it is a personal choice. My labors were 7 and 5 hours, no meds, no tears, no interventions, just beautiful healthy babies. There aren't many births that fit that criteria in a hospital and it's sad....birth is supposed to be natural.

Until this last birth, I never knew just how much power the body had.....my m/w coached me through, allowing my body to do all the work until I just couldn't keep from pushing. It was so hard not to push, but feeling the amazing power of my uterus rising up with each contraction was........I have no words for it! I remember everything about this labor and delivery, everything so clear, I remember Lucas kicking me between contractions in the pushing stage! Oh, if everyone could experience that, the world would be such a better place for women and babies.

[Nurse Jenni]

I am a new LPN, licensed 1 yr this month. When I started Nursing School my long term goal was OB nursing, even before I was out of high school, and I'm still interested, but I would also like to hear more about Midwives. Length of school, eligible states, what ever you can give me!Thanks so much!

[H2OHead]

shame to ruin a perfect pregnancy by placing the baby in danger those last few hours in the home. 10/10's happen at home all of the time, but so do stupid things that could have easily resolved with access to the couple of trillion dollars worth of high tech equipment and unlimited support staff that is found in a birthtday suite at the hospital.

[Cali]

I have worked L&D for 2 years and I would never have a home birth because I have seen perfect labor pt's go downhill in a matter of minutes. I have seen a perfect labor turn into shoulder dystocia which led to a procto-epis cut and an emergency c-section. I'm not knocking anyone who chooses to have a home birth, but for me personally, I wouldn't do it. I have just seen too much. If it's for you, Go For It!

[fergus51]

I think it's odd that women can't have this option if they chose it as no OB doc here will do them and we don't have any midwives either. The litterature all points to it being as safe as a hospital birth for certain women, but they still subjected to scare tactics. A fellow L&D nurse who was a midwife in Britain said the time it takes to get to the hospital (a few minutes) is not wasted because the doc, anesthetist, nurses, would be setting up for the c-section during that time.

[Jolie, BSN]

While I support the right of a patient to choose where she wishes to deliver, it does frighten me to hear of home births, especially with lay mid-wives. There is so little time to respond to a life-threatening emergency in OB, and usually more than one pair of skilled hands is required.

My concern with the notion that time is not wasted in getting to the hospital is this: Most hospitals do not have an OB, an anesthesia provider, and an OR crew in-house 24 hours a day. In most instances, these personnel would not be called in until the patient arrived at the hospital. By this time, it might be far too late for the baby with the prolapsed cord, or the hemorrhaging mother.

There are also a number of unpredictable emergencies that occur at the moment of birth which require back-up. My own baby prolapsed her cord while I was pushing (in a birthing suite, thank God!) And one of the first NICU babies I ever cared for was a beautiful, severely brain-damaged full-term infant who had thick meconium stained fluid that went undetected until the membranes ruptured at the moment of birth. The attending mid-wife was not prepared for this, and had no equipment nor an extra pair of skilled hands to initiate suction or resuscitation measures.

[shay]

Any of you ever see that horrid episode of that AWFUL show, 'A Baby Story' on TLC with the cord prolapse at a home birth?

Here's the breakdown of the pt.:

G2P1, previous home birth attempt followed by a c/s for ftp past 6cms, despite transferring to hospital, getting pit, epidural, etc., etc.. Yep...that's right. A VBAC attempting a home birth.....with a LAY MIDWIFE.

So, anyhoo, long story short, chicky hits 6cms in her birthing pool @ home and the midwife says, 'oh, hold on, I think I feel a cord...get out of the tub..' Checks her on the bed says, 'yep, that's a cord.' REMOVES HER HAND. Tells the pt. to get dressed, they have to have a c/s. Uhhhhhhhhhh.................................

No 911 call was made. Nope. Not at all. The pt. STOOD UP, GOT DRESSED(all the while bemoaning that 'nothing can come out of me without a c-section!!'), AND SAT IN THE FRONT SEAT WHILE HER HUBBY DROVE THE THREE OF THEM TO THE HOSPITAL. She leans against a wall next to the admitting desk in the hospital to breathe through a contraction. The next frame you saw was the pt. in her postpartum room saying, 'yeah, her (the baby) heartbeat was so low when we got here (GEE, I WONDER WHY??) that they had to do a c-section immediately.'

NOW...not every patient that wants a home birth is an idiot. Not every lay midwife that attends a home birth is an idiot. This is an example of an extreme case that went wrong, but it illustrates a point. Why have a home birth??? WHY?? If you want a home-like environment, BE SAFE...deliver at a freestanding birth center that has connections with the local hospital and emergency equip. if something should go wrong. Think of your BABY first, not your own selfish agenda. We have LOVELY freestanding birth centers here that do EXCELLENT jobs with water births, etc., but also have EXCELLENT staff that have the good sense and training to act properly in a medical emergency.

The common argument is that '100 years ago every woman gave birth at home.' Yes, and tell me, what were the maternal and infant mortality rates 100 years ago??? Hmmm??

Stepping off soapbox...

[fergus51]

Shay,

unfortunately women in my area don't have the option of a free standing birth center. It is the hospital, with all of its unecessary stresses and interventions or nothing. I work in the hospital, but even I would have qualms about delivering there. Our c-section rate is over 30% not to mention the episiotomies, unecesary inductions, continuous fetal heart monitoring and a real lack of choice for laboring moms. Some women are fine in the hospital environment and don't mind being controlled by the staff, but others do and depending on what nurse and doc they have the experience can be very bad. A lot of our nurses and docs are very controlling about even the smallest things to the point where I think it's no wonder women would want to have their babies at home.

[OBNURSEHEATHER]

I thought I was the only one screaming at the TV while watching that episode! "Why is she walking around, packing her bag, calling her mother!"

Many years and millions of dollars of technological advancement and discoveries... take advantage of it please.

Heather

[shay]

Fergus, I hear you and can see where your concerns are valid. I agree...hospitals are usually icky places for women who don't want the epidural-in-the-parking-lot kind of birth to have a baby. HOWEVER, no matter how controlling a physician or nurse is, NO ONE CAN FORCE A PATIENT to be on a fetal monitor, be induced, have a c-section, have an operative lady partsl delivery, etc. without her CONSENT. To do otherwise is ASSAULT. Period. Plain and simple. The law is very clear on that matter. This is why I can understand women not WANTING to deliver in a hospital with a 30% c-s rate (ick!), but why risk your baby's life and your own life for the sake of not having to assert yourself or stand up to your doctor? I have taken care of LOTS of patients in the hospital who have had no IV, no meds, no monitor, no NOTHING, delivered standing up at the bedside with no one but the CNM and me present as far as medical staff were concerned.

A 'natural' birth in the hospital IS possible. It is. And the good part is, if, heaven forbid, something were to go wrong, you have the benefit of medical staff and equipment RIGHT there if need be. I understand the not WANTING to deliver at the hospital and having no freestanding bc option, but I just think that your baby's life is much more important than having to be subjected to a less than 'ideal' birth experience. But that's just me.

Anyhoo, I hear you. And that sucks for the women of childbearing age in your community. Freestanding birth centers are wonderful. Too bad women in your community only have the hospital option.

[fergus51]

I think natural childbirth is possible in YOUR hospital would be more accurate;). Of course no nurse can assault a patient, but they use the bullying and scare tactics to get their own way and make the mother to be feel like a selfish b*tch if she doesn't want to go along with everything the nurse says (What? You don't want continuous monitoring? Don't you care about the safety of your baby? You're going to put your baby in jeapordy...). I have never taken care of a patient in that hospital without an IV because most docs won't take women as patients unless they have an IV. I think it's also a lot easier said than done when it comes to refusing a c-section. Most of these women don't have medical training and when the doctor says they need a c-section they believe it (although all the lit says 30% is RIDICULOUSLY high). I have even seen nurses get b*tchy about a woman wanting to change positions, or walk around or have a drink. I personally would not do a homebirth, but I can completely understand why women would chose to when our hospital doesn't even have a better safety record! I think homebirths are the direct result of hospitals being crappy places to deliver. If we had a birth center I would DEFINITELY give birth there!!!

I have spoken with women who call the doctors and nurses control freaks, verbally abusive and egotistical and in some cases I can't even defend them. I go to work everyday and see nurses and doctors so high on their expert knowledge that they are completely unable to show a little respect to their patients and give them some control over their own bodies. Women come in and get treated like 3 year olds. And the "professionals" at our hospital don't really have any incentive to change because we're the only game in town. Until women have other options like homebirth and birth centers why would the hospital put any effort into becoming more welcoming?